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.

The purpose of this descriptive correlational study was to gather data about the perceived health, anginal symptoms and life satisfaction in CABG and PTCA patients. The study explored the interrelationships among the variables and the differences between the two groups. The problem statement was: 1. How do patients perceive their own past, present and future health, level of anginal symptoms and life satisfaction after CABG and PTCA? 2. What are the interrelationships among perceived health, anginal symptoms and life satisfaction in CABG and PTCA patients. The conceptual framework for this study was based on the social theory of symbolic interactionism and the nursing model of man-living-health (Parse, 1981). Perceived past, present and future health, anginal symptoms and life satisfaction were measured by the subject's self placement along 100 millimeter analog scales. Data were obtained in a 30 minute interview with each subject at the time of the patient's first follow-up visit to the physician's office four to eight weeks post procedure. Twenty-two percent of the patients (eight patients) who were eligible for inclusion were included in the study. The means of the scores for perceived health, anginal symptoms and life satisfaction were calculated. The Kruskal-Wallis one-way analysis of variance statistic was used to detect statistically significant differences between the two groups of subjects, and graphs were constructed to illustrate the relationships among the variables. Demographic data were subjected to descriptive analysis by group. The mean scores for the PTCA group were low for the past, only slightly higher for the present, and much higher for the future for all three variables. The mean scores for the CABG group were low for the past and much higher for the present for all three variables. The mean scores for the future were higher for anginal symptoms, but lower for health and life satisfaction for the CABG group. A significant difference was found between the two groups for perceived present health, anginal symptoms and life satisfaction. The mean scores for perceived health, anginal symptoms and life satisfaction assumed a similar curve on a line graph for each group, suggesting a correlation between the variables within the group. Implications for nursing practice apply at primary and secondary levels of prevention. On the primary level, information obtained in descriptive research aimed at identifying commonly occurring perceptions in the CABG and PTCA patient would allow the nurse to begin intervention in the pre-procedure period by clarifying misconceptions and initiating accurate pre-procedure instruction. On the secondary level of prevention, the nurse can begin clarifying these commonly occurring misconceptions early in the recovery period in an attempt to encourage health-promoting behavior choices based on realistic expectations by the patient. Implications for nursing research and education were related to the addition of new information regarding the perceptions of the CABG and PTCA patient.

Most of the richness and beauty of life is derived from the close relationship that each individual has with a small number of other human beings--mother, father, brother, sister, husband, wife, son, daughter, and a small cadre of close friends. With each person in this small group, the individual has a uniquely close attachment or bond. Much of the joy and sorrow of life revolves around attachments or affectional relationships--making them, breaking them, preparing for them, and adjusting to their loss. This study dealt with one of those special attachments, the relationship a child formed with his newborn brother or sister. Much literature has been written on sibling rivalry. The Bible attests to hatred and homicidal impulses related to fraternal jealousy between Cain and Abel, Jacob and Esau, and Joseph and his brothers, to name a few. Greek mythology, as well as English literature throughout the ages, abounds in themes of sibling rivalry. Many psychological studies have been done on older children and adults who had extremely poor childhood sibling relationships, but they also had many other pathologies, and the studies were done in hindsight. Few articles have been written on sibling bonding-- its manifestations and the types of things that might be done to assist in its development. Nursing research is sadly lacking in this area. The mother-infant relationship has received a great deal of deserved attention; studies have produced volumes of information and implications and applications for clinical practice. The father-infant relationship has only recently been recognized as being extremely important. Many fathers are now enjoying and participating in the care of their children. Currently sociologists and psychologists are examining the child's entire social network, one which includes siblings, grandparents, adult friends and peers all of whom appear to serve important functions in the child's life. The experience of becoming and having a sibling is a common situation for many preschool children. The addition of a new infant to a family with a preschooler presents a unique challenge to parents. Since professional Nursing is concerned with the well-being of families and their development of healthy, mutually satisfying relationships, it is important that the nurse gain an understanding of sibling relationships. Before she can help individual family members meet their needs, she must observe interactional patterns. Nurses are often involved with a family. This involvement provides opportunities for obtaining an overview of the life cycle--pregnancy, childbirth, and early days and years of the children’s lives. The involvement gives nurses the opportunity to collect data from the families directly and to provide anticipatory guidance, e.g., concerning preparation of a child for a sibling and support of healthy coping mechanisms. Certainly the emphasis of pediatric health care today is on prevention rather than simply alleviating the symptoms of diseases. More attention to the needs of the developing family could foster positive relationships and prevent disturbances in family life. It has been noted by the investigator in her professional experience that parents have questions concerning sibling relationships, especially around the time of childbirth. It was hoped that this study would reveal information which might be helpful to nurses, pediatricians, obstetricians, and others who provide anticipatory guidance for parents.