Heart failure (HF) is a diagnosis associated with significant mortality, morbidity, and healthcare costs. One in four patients with HF have an unplanned readmission within 30 days of discharge. Few interventions that seek to decrease readmissions target the discharge planning process during the acute hospitalization or account for the contributions of bedside nurses. Bedside nurses’ decision-making and motivation surrounding discharge planning for frequently readmitted patients with HF has not been described. Therefore, the purpose of this interpretive descriptive study was to understand bedside nurses’ motivation and decision-making during discharge planning for adult patients with HF on a telemetry step-down unit within a large, Magnet-designated, Midwest hospital. In order to achieve the aims of this study, Self-Determination Theory (SDT) was used as the organizing structure. SDT is generally defined as the motivation to act based on the degree of 1) autonomy, 2) competence, and 3) relatedness felt by bedside nurses. Fifteen bedside nurses were interviewed. Coding was done using Nvivo and thematic analysis was completed. Two members of the research team reviewed the coding and a nurse consultant who was not interviewed reviewed the nurse researcher’s identification of themes related to the three domains of SDT: autonomy, competence, and relatedness. The major finding was that bedside nurses described high levels of motivation to do effective discharge planning despite many barriers, such as lack of physician-nurse communication and "surprise" discharges. The nurses reported being motivated when they had a broader knowledge of methods to deliver HF education (felt competent), had time to establish a personal connection with patients (relatedness), and did not feel rushed to complete HF discharge planning tasks. Autonomy did not emerge from nurses’ responses to the degree that competence and relatedness did, but when it did emerge, a strong sense of autonomy was apparent (acting out of personal choice). Findings of this study emphasized a need for effective HF discharge planning to be established as an important competency for bedside nurses and for interdisciplinary relationship-building between nurses, patients, and physicians to be factored into the organizational culture. The SDT framework provided a unique lens to better understand the decision-making and motivation that bedside nurses have toward HF discharge planning and how work conditions can facilitate or constrain their natural tendencies to deliver effective patient-centered care to patients with HF.

Clinicians have a challenge of discovering and implementing new ways to address their patients' health concerns. Some healthcare needs are not completely managed with pharmacotherapy and invasive procedures alone. Military veterans compose a special group due to multiple needs related to physical and emotional symptoms resulting from exposure to trauma. This project explored the benefits of a Tai Chi recreational therapy program. The goal of this trial was to examine gentle movement routines of Tai Chi for emotional benefits for veterans. The literature review provided insight from current evidence into the probable outcome of including alternative medicine options into regular practice for veterans coping with mental health illness. Veterans can find Tai Chi effective for self-management of anxiety, simple strength building and positive social interactions. With better management of mood symptoms from the practice of Tai Chi, pharmacotherapy use may be reduced. The Kirkpatrick model was used to evaluate the effectiveness of training. Although a small sample (n = 9), the results from patients via open ended questionnaire about their Tai Chi experience confirmed its benefit for better management of anxiety symptoms, as well as increased stamina and reduced back pain. Tai Chi has the potential to offer an independent method for managing various symptoms. Complementary alternative medicine such as Tai Chi should be seriously encouraged for self-management of various emotional and physical symptoms. Tai Chi practice incorporated into treatment plans contribute to social change by reducing medicinal use, symptoms exacerbation and financial cost for treating symptoms.

Five to 27% of all pediatric medication orders lead to errors and play a significant role in the morbidity and mortality of the pediatric patients admitted to hospitals. The practice problem explored the high rate of medication errors in the pediatric intensive care unit (PICU) of the project site, where the population is particularly vulnerable due to their acute illnesses. The purpose of this project was to analyze the root causes of all cases of medication error in this hospital's PICU during the last 2 years. The literature review was used to categorize secondary data extracted from the hospital's quality assurance database. An analysis of the 41 total medication errors showed that 49% of the medication errors made in the PICU were due to the nurse administering the incorrect dose of medication. Most (60%) occurred on the day shift when the unit was busy and the patient's medication orders were constantly being changed. Missed doses' €”mostly due to oversight and ineffective follow-€up by clinical staff, pharmacy, and providers €accounted for 27% of the medication errors. There were instances in which the physician and the pharmacy did not properly order and verify a medication. The summary of the root cause analysis and recommendations from the literature for improved clinical practice will be presented through the hospital's quality assurance structure. Recommendations include implementing computerized physician order entry, regular education of staff, involvement of the pharmacist in new medication orders, updated nursing protocols, and support systems for decision making. The implications of this project for positive social change include the impact of improved practices on decreasing medication errors and improving health outcomes in the PICU population.

Hospital-acquired infections (HAIs) are a significant problem faced by healthcare organizations globally. The Centers for Disease Control reported that in 2014, 722,000 patients acquired an HAI, and of those, 75,000 died as a result. This project focused on reeducating healthcare staff on hand hygiene practices to prevent HAIs. Preintervention hand hygiene compliance rates were compared to postintervention hand hygiene compliance rates on 2 units in an acute care setting to evaluate if reeducation of healthcare staff on hand hygiene protocols and practices would increase hand hygiene compliance rates. The evidence-based practice model used for this project was Nightingale's environmental theory. The research question for the study examined the effectiveness of hand hygiene reeducation on hand hygiene compliance rates. Participants included 97 nurses and ancillary staff. Hand hygiene compliance rates were compared 1 month before and 1 month after healthcare staff reeducation. Results showed an 18% increase in compliance rates following reeducation. These results might effect positive social change by reinforcing that reeducation has an impact on compliance rates for hand hygiene among nursing and ancillary staff in acute care settings.

The purpose of this educational influenza vaccination project was to increase nurses' influenza vaccination rates. Nationally, 41% of nurses were vaccinated, which is far below the Healthy People 2020 goal of an influenza vaccination rate of 90%. Literature suggests that the low nurses' vaccination rate is responsible for inpatient healthcare associated influenza, mortality, and influenza-like illness. Healthcare facilities will not be reimbursed for treatment of healthcare associated infection. Despite recommendations from the Centers for Disease Control and Prevention for nurses to become vaccinated, only 20% of the 800 nurses at a healthcare facility in Baltimore were vaccinated for the past 2 years. A literature search for evidence-based articles was done electronically. Databases such as CINAHL, PubMed, and Medline identified 450 scholarly articles on attitudes, perceptions, and benefits of vaccination. Twenty-one scholarly articles written from 2006 onward that referenced increasing nurse vaccination rate were selected. Pender's health promotion model provided a conceptual view on beliefs and attitudes while explaining the delay in nurses to becoming vaccinated. Based on these scholarly sources a Power-Point presentation was developed that included 10 educational sessions. Five advisory committee members of experts were contacted via e-mail and telephone to review the educational project for feasibility and content validity. The advisory committee members commented that the educational project was feasible and relevant to the content of influenza vaccination for nurses. Social change will focus on nurses adapting a change in practice, and increasing their vaccination rate as a result of this evidence-based educational project.

Research has documented numerous risks and complications in the use of indwelling urethral catheters.1 In spite of this, indwelling catheters are still widely used for the management of incontinence.2 During the past four decades, studies have shown that incontinence can be managed or resolved in many patients by using intermittent catheterization. Early investigators used elaborate sterile technique and included only patients with neurogenic bladder as a result of spinal cord injury.3 Later studies showed favorable results in patients with incontinence of non-traumatic etiology--even in patients previously dependent on an indwelling urethral catheter.4 The early literature on sterile technique occasionally mentioned teaching self-catheterization to those patients capable of learning the aseptic procedure, but this was apparently uncommon. In l972,Lapides introduced the use of clean technique intermittent self catheterization for the treatment of a diversity of bladder dysfunctions. The results were equivalent bacteriologically to those with sterile technique and the simplicity of the procedure made it convenient and acceptable to many patients.6 During three years experience as a staff nurse in a visiting nurse association, the investigator worked with numerous patients who used indwelling urethral catheters on a permanent or semi-permanent basis and to whom nursing visits were made solely for the purpose of changing the catheter. Frequently, the catheter had been placed for incontinence without urodynamic evaluation. In many cases, the individuals caring for the patient in the home were responsible and competent. The investigator read about Lapides' research as part of graduate education and was impressed with positive results obtained even when the patient had lengthy previous dependency on an indwelling catheter.7 The investigator questioned whether there were patients with indwelling catheters living at home for whom this alternative had been overlooked and whether some of the competent caretakers could be taught the procedure in cases where the patient was not a candidate for self-catheterization. Numerous benefits would result if a patient were freed of an indwelling urethral catheter by using intermittent catheterization: the costs of sterile equipment, personnel and transportation involved in catheter changes would be eliminated; the nurses' time would be freed for other responsibilities; medical complications and their inherent costs would be averted; and freedom from tubing and bag would permit greater mobility for the patient and simpler handling by the family. An investigation was planned to examine the relationship between bacteria in the urine and the use of clean technique intermittent catheterization when used following removal of an indwelling catheter. Previous research demonstrated that, in the absence of symptoms, microscopic visualization of bacteria in fresh, centrifuged urine sediment was highly predictive of growth on culture of 100,000 or more colonies per milliliter (ml.).8 Robins et al. suggested that the reliability of microscopy for predicting positive culture results was further enhanced by visualizing leukocytes as well as bacteria.9 Since the procedure of microscopic examination is inexpensive and can easily be learned by nurses, this test could be useful in monitoring bacteriuria in asymptomatic patients using clean technique intermittent catheterization.

"Cardiovascular diseases claim more American lives than all other causes of death combined,”1 as stated in the American Heart Association's Heart Facts 1975. In 1972, it was estimated that 1,036,560 individuals died of cardiovascular disease; 683,100 of these were attributable to acute myocardial infarction.2 In addition, an estimated 28,420,000 Americans have some type of cardiovascular disease at a cost of $20 billion annually.3 The figures ”bring home" a stalking reality; cardiovascular disease is epidemic in this country, the incidence and ramifications of which make it an ever-present threat to all Americans. The greatest threat is heart attack, tragically bearing the distinction of ”the nation's number 1 killer.”4 Since it is estimated that 3,940,000 Americans have some history of angina pectoris or myocardial infarction,5 the problems associated with readjustment to living following myocardial infarction are of great concern to many, foremost to the victims themselves and their families. Among these adjustment problems are fear of pain and death, anxiety, and depression. Change in lifestyle may be necessary in the areas of diet, activity, job, and family rights and responsibilities.

University health services play a very important role in the general health, performance, and well-being of the students, the university itself, and the community. As stated by the American College Health Association, the goal of a university health service is to "promote and maintain those conditions which will permit and encourage each individual to realize optimum physical, emotional, intellectual, and social well-being." University students have special health care needs such as drug and alcohol abuses, emotional problems, and gynecological, sexual, and contraceptive problems. It is the goal of the health professionals involved with students to meet those needs. Because of these special health care needs, the increasing number of university students, and the present problems associated with medical care and medical distribution, nurse practitioners have become involved in some university percent of these nurse practitioners are in college health services.3 It was believed by the investigators of this study that nurse practitioners could play a special role in this area of health care. As student health medical directors are key persons in defining nurse practitioner activities, the purpose of this study was to determine the activities the directors identified as appropriate for nurse practitioners to perform in a university health care setting. The type of activities identified by them may be crucial in the decision to utilize nurse practitioners in the university student health setting.

The purpose of this study was to determine the extent to which executive nurses participate in strategic planning for their institutions,and the extent to which these executive nurses utilize the strategic planning process for their nursing departments. The effect of ownership, size, and educational level of the executive nurse on the extent of participation in institutional strategic planning and the utilization of the strategic planning process for their nursing departments was also examined. The population of the study included all executive nurses employed in short-term, nonmiltary, Virginia hospitals, which were members of the Virginia Hospital Association. Questionnaires were mailed to 114 executive nurses, 60 returned the survey with a response rate of 53 percent. The 60 hospitals included: 14 small institutions (< 99 beds), constituting 24 percent of the sample; 30 medium-sized institutions (100-399 beds), comprising 58 percent of the sample; and 11 large institutions (> 400 beds), constituting 18 percent of the sample. There were 48 not-for-profit institutions constituting 80 percent of the sample, and 12 for profit (investor owned) comprising 20 percent of the sample: and 11 large institutions (> 400 beds), constituting 18 percent of the sample. There were 48 not-for-profit institutions constituting 80 percent of the sample, and 12 for-profit (investor owned) comprising 20 percent of the sample. The typical nurse executive in this study held a master's degree, had 21-25 total years of nursing experience of which one to five years was at the executive level, and had been in his/her present position one to five years. Slightly over half of nursing departments had long-range plans covering three years or less. The majority of long-range plans for the department of nursing were formulated by the strategic planning process. Participation in hospital strategic planning was influenced by the institution's size and the nurse executive's educational level. Utilization of the strategic planning process for the department of nursing was influenced by neither size nor ownership, only the executive nurse's educational level.

Twenty ASA class I and II patients between the ages of 15 and 64 years undergoing surgical procedures requiring neuromuscular blockade and general anesthesia were selected at random to participate in this study. Patients taking medication known to interfere with neuromuscular blockade were excluded. All patients were given 2 mg of midazolam IV as a premedication. In the operating room, routine monitors were connected and baseline blood pressure, pulse and respirations were recorded with subsequent recordings at 5 and 10 minutes following induction of anesthesia. Indirect stimulation of the ulnar nerve was achieved by placing ECG electrodes 2 cm and 10 cm proximal to the distal end of the ulnar nerve. The same type ECG electrodes were used at the orbicularis oculi muscle group. One electrode was placed 2 cm lateral and 2 cm caudal to the outer canthus of the eye and the second 2 cm caudal to the first. Induction of anesthesia was achieved with mivacurium 0.1 mg/kg IV followed by fentanyl 100 mcg IV and propofol 2 mg/kg IV. The second dose of mivacurium 0.1 mg/kg was administered 30 seconds after the initial dose. Baseline twitch response was started at both monitoring sites using 1 Hz twitch mode with an output of 60 mA. Each patient was monitored until there was a loss of twitch response at either of the two sites. When the twitch response was suppressed at one site, the anesthetist performed direct visual laryngoscopy. If the vocal cords were open, the trachea was intubated. The time of twitch suppression at the second site was also recorded. The data collected from the study was examined using a paired t-test and a comparison of the mean times to loss of twitch at the orbicularis oculi and the adductor pollicis was made. All 20 of the subjects lost the orbicularis oculi motor response to stimulation prior to the loss of motor response to stimulation at the adductor pollicis. The mean time to loss of twitch response was 85 seconds at the orbicularis oculi and 230 seconds at the adductor pollicis. It was concluded that there is a shorter time to loss of twitch response at the orbicularis oculi than at the adductor pollicis using 0.2 mg/kg mivacurium chloride in equally divided doses given 30 seconds apart.