Tobacco has been recognized as the number one cause of preventable death in America and results in almost 5.2 million years of potential life lost each year. The use of tobacco products is highly correlated with pulmonary disease, cardiovascular disease, and other forms of chronic illness in America. Within the last ten years new tobacco products have been trending in the tobacco market such as the water pipe/hookah and e-cigarettes. With e-cigarettes and other newer forms of tobacco on the rise, it is important to look at the underlying factors for using all kinds of tobacco products as a means of prevention. Certain adult attachment styles (secure, preoccupied, dismissing-avoidant, and fearful-avoidant) in emotionally meaningful relationships could be indicators for physical illness, mental illness, and even addiction. The researcher implemented a study that investigated whether or not there is a relationship between tobacco use and attachment style. Based on a university-wide survey that was sent out at East Tennessee State University with 522 participants, demographic data revealed 68.5% (n=358) did not currently use tobacco products. However, of those who did currently use tobacco products 54.5% (n=90) were male, 84.8% (n=140) were undergraduate students, and 66.7% (n=110) were between the ages of 18-25. For individuals who used tobacco 23.5% (n=38) were in the secure attachment group, 27.8% (n=45) were in the dismissing-avoidant attachment group, 30.2% (n=49) were in the fearful-avoidant attachment group, and 18.5% (n=30) were in the preoccupied attachment group. Chi Square analysis demonstrated that attachment style was significantly (p < 0.01) different between tobacco users and non-users. For anxiety, r=0.00209, which was weak. For avoidance, r=0.18875, which was slightly higher than the effect size for anxiety, but it was still weak. Considering that there was significance but the effect size was weak, the recommendation is that the study be repeated with a broader sample.

This study compared two methods of postcesarean fentanyl patient- controlled analgesia (PCA). Fentanyl was administered intravenously (PCAI) or epidurally (PCAE) following cesarean section under epidural chloroprocaine anesthesia. Twenty-one ASA I and II parturients were randomly assigned to receive fentanyl PCAI (n = 9) or PCA (n = 12). At surgical completion fentanyl 1.0 mcg/kg was given and the PCA initiated with a dose of 30 mcg, a lockout interval of 10 minutes, a maximum dose of 180 mcg/hr, and no basal rate. Data were collected over 24 hours including visual analog scale (VAS) pain scores, plasma fentanyl levels, total fentanyl usage, and side effects. Surgical time was significantly longer for the PCA, group (p = 0.0213). There was no difference in VAS scores until 24 hours when the PCAE group’s were significantly lower (p = 0.0295). The PCAE group almost always had lower VAS scores. Total fentanyl usage was significantly lower for the PCAE group (p = 0.050). There was no significant difference in plasma fentanyl levels, side effects, or patient satisfaction. The data revealed that both methods provided adequate postoperative analgesia and epidural fentanyl provided both local and systemic mediated analgesia.

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This study explores the opinions and experiences of East Tennessee State University (ETSU) male nursing students after they have completed their clinical rotations in obstetrics (OB). Participants are interviewed about their preconceptions and post-experience perspectives regarding the clinical rotation. After analyzing the interviews, the students’ perceptions appeared to be grounded in their perceived level of comfort with women’s health nursing. Themes include (1) preconceptions, (2) welcoming, (3) rejecting, and (4) culture.

The present study investigated the existence of bullying by medical staff members in the clinical setting as experienced by nursing students, the existence of burnout among these students, and if such students perceive feelings of burnout as directly related to experiences of bullying. Undergraduate main campus traditional Bachelor of Science in nursing students at East Tennessee State University in their second, third, fourth, or fifth semesters were invited to participate in the study. Participants (n=52) were required to complete an online survey that regarded bullying, burnout, and how participants perceive the relation between the two variables. The study shows that over half of participants had experienced at least one bullying instance in the clinical setting. Furthermore, over half of participants reported they had used the term “burnt out” to describe their feelings toward their nursing education more than seven times and reported a decreased desire to continue their nursing education at least some of the time. Over half of participants reported that their feelings of burnout were directly caused by experiences of bullying at least some of the time. This study shows a significant existence of both bullying and burnout among nursing students at ETSU and that most nursing students sense bullying as a cause of burnout at least some of the time.

Introduction and Background: A widespread issue that is affecting patients and nurses alike is the ongoing prevalence of registered nurse shortages in the field of healthcare. This obstacle has jeopardized exceptional patient care for many years and research suggests there is a need for interventions to combat the growing shortage. Purpose Statement: This research aimed to investigate how the lack of acceptable nursing staff levels affected patients’ quality of care, safety, and outcomes in various healthcare settings. It also emphasizes the need for interventions that would focus on the supply and retention of nursing staff in order to combat the bleak outlook that nursing shortages have in relation to the goal of patient centered care. Literature Review: Journal articles were found utilizing subscription of the East Tennessee State University Library’s database to access peer reviewed articles using keywords such as shortage, missed care, safety, and registered nurse. The most used database was PubMed. A total of 5 articles were selected after excluding those conducted before 2018 to maintain relevancy. Findings: The findings of this research suggest that the nursing shortage negatively effects patients in hospitals, long term care facilities, and those requiring at-home nursing, resulting in care omissions, higher mortality rates, and increased negative perceptions of nurses. Conclusion: While there is more research needed to indicate the cause of nursing staff shortages, it is evidenced to be an international issue that jeopardizes patients and requires further attention in order to ensure that patient safety and satisfaction is invariably achieved.

Background: According to Park, et. al. (2021) a flipped classroom consists of pre-class activities that expose students to the subject matter, in-class activities that promote interaction between classmates, learners and instructors and post-class activities that help solidify information. This method of education is thought to be more effective at promoting clinical judgement than traditional lecture-based classrooms. Delivery of course content through virtual meetings can also allow for additional flexibility in students’ schedules, while still allowing for engagement with classmates and promoting students’ engagement in their learning and motivations to learn (Philips & O’Flaherty, 2019). The nation-wide restrictions on 2020-2021 academic year required that all courses in the Nashville State Community College department of nursing be transitioned to an online format with mandatory weekly meetings with students via videoconference. To facilitate this transition, a flipped “virtual classroom” approach was implemented for the Medical-Surgical Nursing 2 course. Implementation: The course operated on a weekly schedule, with a format of asynchronous lecture content, homework assignments and synchronous online meetings. Asynchronous lecture content: asynchronous lectures were provided as 10-40 minute videos and presented in .mp4 format. The majority of students spent 2-4 hours viewing recorded lecture content. Homework assignments: each week, students spent an average of 1-2 hours outside of the scheduled class time completing homework assignments. Homework assignments served to help students apply the course material and consisted of several short case studies, one long-form patient case study, flowcharts or concept maps. Synchronous online meetings: synchronous online meetings were held via videoconference at a set date and time each week. Student attendance at meetings was mandatory. In synchronous online meetings the instructor reviewed the material from the homework assignments using online polling or quizzes, discussion and student feedback. Synchronous meetings were automatically recorded and provided for student review. Evaluation: Student learning outcomes: course outcomes for each student cohort are evaluated based on student achievement on nationally normed, standardized tests. The score designated by NSCC indicates mastery of content in the 50th percentile or higher nationwide. In two virtual semesters, 100% of students achieved the designated percentile on standardized tests. The average percentile rank was 91.8%. Student feedback: A total of 27 students were polled via survey monkey. Student feedback was generally positive: 81% of students ranked this course format as better than online courses that contained only asynchronous lecture with no weekly meetings or outside assignments. 93% of students ranked this course format as better than online courses that contained only synchronous lecture via videoconferencing. In addition, 63% of students ranked this course format as better than fully in-person courses. Implications: Course outcomes were met for both virtual semesters and students responded positively to the course format. This suggests that the virtual flipped classroom approach can be used to achieve student learning outcomes.

Abstract Introduction & Background: One of the most common and debilitating side effects of cancer is fatigue. Fatigue is a general feeling of tiredness or weakness that can greatly impact a patient’s quality of life. It can have a profound impact on a patient’s ability to perform day to day activities and cause emotional distress leading to anxiety and depression. In recent years, there has been an increase in research to look at the effectiveness of non-pharmacological interventions on improving cancer patients’ fatigue. Purpose Statement: The purpose of our research is to look at the effectiveness of different types of non-pharmacological interventions on improving fatigue in lung cancer patients. Literature Review: The ETSU Library Database was used to locate the articles reviewed for this research. Only articles that were peer reviewed, open access, and available online were used. Articles that were published in 2016 or before were eliminated in the search to ensure the research’s relevancy. A total of five articles were selected to be reviewed. Findings: Progressive muscle relaxation therapy, physical therapies such as acupressure, acupuncture, and transcutaneous electrical acupoint stimulation, psychological intervention using the PERMA framework, and light exercise and balance programs consisting of walking in place showed an improvement in cancer patients’ level of fatigue. Conclusions: Non-pharmacological interventions for fatigue, compared to traditional pharmacological treatments, prove to have fewer adverse side-effects and risks for the patient. Therefore, these interventions are a safer and effective option in managing the distressing symptoms like fatigue that many lung cancer patients face while undergoing treatment.

Background: Nursing competencies are important for quality of care, patient safety, and identifying gaps in knowledge and skills. Patient harm has been linked to a lack of competency and insufficient policy and procedures. Purpose: The purpose of this quality improvement project was to achieve standardization of nursing competencies within nurse-led clinics. Aims: The aims of this project were to validate select competency days and determine the satisfaction of the competency days by the participants. The second aim of this project was to develop an electronic tracking form. A third aim was to develop and present a policy and procedure for competency assessment for approval. Methods: Two competency days were held in February of 2024. A Google form was created to aid in the tracking of competencies. Validation methods were return demonstration and post-tests. At the end of the check-offs, participants completed a 5-point Likert scale satisfaction survey. Findings: Six nurses (n=6) participated in the competency days. Based on the satisfaction survey, all participants (n=6) found the competency day beneficial and promoted confidence in performing nursing skills. Conclusion and nursing implications: All participants found the competency day beneficial. The competency policy and procedures are currently under development. Once developed, the policy, procedure, and tracking form will be reviewed by the director of quality compliance, clinical directors, and chief nursing officer for approval and implementation in all nurse-led clinics within the organization.

<p>Safe nursing care of patients with cardiovascular disease requires specialized knowledge and skill. However, education for such specialty practice has little empirical basis. Research has suggested that novices perceive primarily surface aspects of a domain while experts perceive primarily its deep principles. Insight into such perceptual differences may help inform future pedagogical strategies. The purpose of this study was to investigate whether or not such differences are found in the domain of cardiovascular nursing.</p> <p>A forced choice triad task was developed to test the study hypothesis. Each triad trial consisted of a target item and two referent items. Referent items were designed to be similar to target items based on surface features (S) such as patient age or sex, deep features (D) such as the goal of therapy, or both surface and deep features (S/SD). Participants were asked to choose the referent item that they believed was more similar to the target item and to provide a rationale for their choice. The instrument was completed by n=17 nurses in two practice cohorts: a novice/less experienced cohort with less than three years of experience in cardiovascular nursing and an experienced/competent cohort of Nurse Practitioners with at least ten years of experience in the specialty.</p> <p>Statistically non-significant differences in scores between study cohorts occurred in the hypothesized direction. However, due to the small final sample size, no definitive conclusions could be made based on this study's findings.</p> / Master of Science (MSc)