Regardless of the setting, medication errors are of great concern when associated with an individual’s health outcomes, along with the increased costs to society, healthcare institutions, and providers. Current research focuses on medication error data primarily in acute and extended care facilities. However, there is a paucity of research examining the causes of medication errors that occur post hospital discharge when individuals transition to the home. The purpose of this integrative literature review is to examine risk factors for medication errors outside of these settings, specifically in the home. A systematic literature search was conducted using multiple databases for relevant articles in the English language between 2006 to 2017, including CINAHL, MEDLINE, PubMed, and PsycINFO. Search terms included ‘medication errors’, ‘home care’, ‘post-discharge’, ‘hospital readmission’, and ‘medication error risks in the home’. Exclusion criteria included medication errors in acute and extended care settings. The integrative review involved reading, analyzing and selecting articles, and summarizing on a matrix. Findings on occurrences of medication errors in the home included impaired client mental status, confusion related to medication names, limited understanding of medication purpose in the care plan and its side effects, level of health literacy, and client-provider miscommunication in discharge planning. Consistent and conflicting findings are discussed along with gaps in the literature. Limitations and implications for nursing practice, policy, research, and education are also noted.

The primary purpose of this research was to examine the effects of HRT in women with acute estrogen deficiency from surgically induced menopause. The secondary purpose was to evaluate how HRT improves symptoms of acute estrogen deficiency and quality of life (QOL) in women using hormone supplementation. Peer reviewed articles published from 2000 to 2017 that were written in the English language with a focus on the use of HRT in women with acute estrogen deficiency after surgical menopause were evaluated for relevance. Evidence suggests the primary reason for decreased use of HRT is the associated risks outweighing the benefits; however, this is not reflected in health care provider's (HCP's) clinical experience. HCP's were more likely to prescribe HRT for themselves or family members if they were experiencing the negative side effects of estrogen deficiency due to surgical menopause, but not to women in their care with similar clinical manifestations of menopause. Additionally, serious risks associated with HRT for acute estrogen deficiency remain incongruent with HRT for women experiencing natural menopause; although risk for breast cancer due to HRT was a universal concern. Risks of HRT related to thromboembolism, stroke and heart disease, were discussed with comparison to the undesirable clinical manifestations of menopause. Results indicate further education and research is needed that explores the risks and benefits for HRT in women with sudden onset of estrogen deficiency from surgical menopause.

Glass particle contamination of medication occurs when opening ampules which may cause patient harm. The use of filter needles reduces this risk. Many anesthesia providers use ampules daily, but do not use filter needles when aspirating medications from ampules. In addition, filter needles may not be readily available at the anesthesia medication preparation site. Not using filter needles or having them available for use can increase the risk of patient harm by glass particle contamination. The purpose of this project was to increase anesthesia provider’s knowledge thereby improving compliance with evidence-based standards when preparing medications from ampules. The goal is to increase filter needle use when medication is aspirated from an ampule in order to decrease the risk of glass particle contamination to the patient. This project consisted of a one-group pre/post intervention design using a piloted self-developed survey, an education intervention, and tracking of filter needle use. The convenience sample of eighty-three recruited anesthesia providers included anesthesiologists, nurse anesthetists, and anesthesiologist assistants that consented to participate. The filter needle inventory was tracked via an existing software program to determine filter needle use three months prior and three months after the intervention. Data were collected and analyzed using descriptive statistics. The results of this project found greater awareness among participants of standards and organizations regarding filter needle use with ampules, greater awareness of availability of filter needles on anesthesia carts, and a five-fold increase in filter needle usage by participants three months following the intervention as compared to three months prior to the intervention.

Intimate partner violence (IPV) is recognized as a serious, growing problem on college campuses. IPV rates among college students exceed estimates reported for the general population. Few studies have examined the impact of IPV among the Hispanic college student (HCS) population or explored how HCSs perceive and experience IPV. Focusing on young adults (ages 18 to 25 years), this mixed methods study was designed to explore the perceptions and experiences of IPV focusing on levels of victimization and perpetration in relation to gender role attitudes and beliefs, exposure to parental IPV, acculturation, and religiosity. A sample of 120 HCSs was recruited from two south Florida universities. A subsample of 20 participants was randomly selected to provide qualitative responses. All participants completed a series of questionnaires including a demographic survey, the FPB, CTS2-CA, SASH, ERS and CTS2. Bivariate correlational techniques and multiple regressions were used to analyze data. Marked discrepancy between participants’ perceived experience of IPV (N = 120) and their CTS2 responses (n = 116, 96.7%). Only 5% of the participants saw themselves as victims or perpetrators of IPV, yet 66% were victims or 67% were perpetrators of verbal aggression; and 31% were victims or 32.5% were perpetrators of sexual coercion based on their CTS2 scores. Qualitative responses elicited from the subsample of 20 students provided some insight regarding this disparity. There was rejection of traditional stratified gender roles. Few participants indicated that they were religious (20.8%, n = 25). Evidence for the theory of intergenerational transmission of violence was noted. Recall of parental IPV was a significant predictor of level of IPV victimization (β = 0.177, SE = 0.85, p = 0.041). Nursing and social service providers must be cognizant that contributing factors to either victimization and/or perpetration of IPV among college students must be addressed first (i.e., perceptions of IPV), both in acute (i.e., emergency department) and community (i.e., college and university) settings for optimum intervention outcome.

Phantom limb pain may occur after the accidental removal or surgical amputation of a limb. Phantom limb pain is the experience of pain in the limb that is no longer present. The clinical management of phantom limb pain is essential in the overall reduction of patient rehabilitation and poor patient outcomes. A patient’s degree of phantom limb pain is influenced by their personal response to loss and pain and can have devastating effects to a person’s social performance, occupational role, family role, relationships, and involvement in activities or hobbies. Like most chronic pain, phantom limb pain decreases the quality of life. Not all amputees who suffer from chronic pain respond to traditional therapies. The purpose of this integrated review of the literature was to explore current research and determine the efficacy of mirror therapy in the treatment of Phantom limb pain in amputees. A database search of CINAHL, PubMed (MEDLINE), and OneSearch was conducted. Mirror therapy had no reported side effects, was inexpensive, and was capable of being practiced at home and at the bedside. Relevant findings in the literature revealed a significant decrease in phantom limb pain when using mirror therapy for more than 4 weeks. Although limited research on the use of mirror therapy as an intervention for amputees, existing research supports the efficacy of mirror therapy for the management of phantom limb pain. Nurses and healthcare providers need education on mirror therapy to advocate for their patients to ensure the best possible outcome and reduction of phantom limb pain. Further research on mirror therapy is needed.

Associated with health care reform, there has been a growing interest among healthcare professionals regarding use of energy-based therapies as a complementary therapeutic intervention. The purpose of this integrative literature review was to examine the impact of energy-based therapies (i.e. healing touch, reiki, therapeutic touch) on patients’ postoperative recovery. The methodology included identifying appropriate peer-reviewed, English-language research articles on the topic area that were published between 2006 to 2018. Following a search in select data bases, articles focusing on the topic were critiqued, analyzed and synthesized by the researcher. Consistent and inconsistent findings along with gaps in the literature are noted. In general, the research supported positive postoperative recovery outcomes when energy-based therapies were included along with standard postoperative nursing care. This theses highlights implication for nursing practice, education, and policy and identifies study limitations. Given that research is limited on this topic area, additional studies are needed to establish supporting evidence to ascertain the effects of energy-based therapies when used as a complementary postoperative intervention.

Limited research exists about the experiences of nurses’ caring for patients during the COVID-19 pandemic post hoc. To understand nurses’ realities of caring for patients with COVID-19, I aimed to understand the lived experience of nurses caring for patients with COVID-19 in the United States. A qualitative design with a hermeneutic phenomenological methodology was used. Sixteen participants were recruited via purposive sampling, augmented with snowball sampling. Data were collected through unstructured interviews and were analyzed using Braun and Clarke’s Reflexive Thematic Analysis. Nurses’ experiences of caring for patients with COVID-19 in the U.S. were consolidated into four themes: “a living hell”; “rationing patient safety”; “mental aftermath of the war zone”; and “post-pandemic pride”. Nurses provided patient care amidst challenging environments of limited to no resources, with extensive, large-scale critically ill patients, and patient deaths. Due to overwhelming patient care demands, nurses were unable to provide safe patient care to everyone in need, resulting in patient deterioration and death. These experiences caused nurses to endure maladaptive mental effects, such as compassion fatigue and moral suffering, which can threaten the safety of patients. Despite these undesirable results, nurses continued to provide patient care and expressed feelings of pride in the profession of nursing for surviving the COVID-19 pandemic. However, this study demonstrates the persistent impacts on nurses’ abilities to provide safe care after the crisis years. Support for nurses is recommended to preserve patient safety.

The quality of care in our nation’s long term care facilities or nursing homes has been a steadfast matter of public policy for the past few decades. In response to research and reports of poor care, the Nursing Home Reform Act (NHRA) was born in 1987. Since that time, additional legislation has been passed to address the same issue. Continued research in early 2000 has shown that although there have been strides toward increasing the quality of care in these facilities, serious care issues continue to exist. As part of NHRA, every long term care facility in this country that accepts payment from the federal government must complete a survey every nine to fifteen months. There are two types of long term care surveys: the traditional and quality indicator survey (QIS). Recent research has documented that both survey processes are flawed. To date, the federal government has no way to monitor whether QIS is meeting its objectives. The purpose of this quality improvement project is to evaluate the use of a tool to assess surveyor efficiency and effectiveness on each survey task in the long term care survey. A tool was developed to evaluate surveyor efficiency and effectiveness and a pre-pilot was completed in early March of 2014, to test the tool. The outcome of that testing was that data collection was complex; many of the survey tasks were conducted simultaneously making it impossible for one researcher to conduct the evaluation. At the same time, the participating healthcare organization decided that another project took precedence. Although the project never was completed, the evaluation of surveyor efficiency and effectiveness is recommended in further research, as thousands of residents in long term care facilities depend on the survey process to ensure high quality of care.

Mental health is an ever-growing crisis among adolescents and young adults, with suicide as second leading cause of death and the number of those negatively affected continually on the rise. Transitions are one of the major stressors prevalent among these age groups, placing individuals at risk for mental health deficits. This quantitative voluntary response comparative study assesses the transitional mental health of pre-nursing students and students in the nursing program at East Tennessee State University. Emailed to all with a declared major of pre-nursing or nursing, this study measured mental health using evidenced based assessment tools. The PHQ-9 for depression and the GAD-7 for anxiety, along with additional demographic information and mental health service usage questions, was sent to and completed by participants. A total of n = 173 responses were received. Of these responses n = 99 or 57.2 percent were nursing students, a participation rate of 9.6 percent, and n = 74 or 42.8 percent were pre-nursing students. The research revealed that depression and anxiety scores were above the cutoff for moderate depression and anxiety in both groups, as well as identified a deficit in availability of mental health resources, with over 10 percent of students unable to access counseling or psychiatric services. Contraindicatory to literature, which predicted improving mental health in the progression through university studies, this study reveals a variable and even worsening trajectory of mental health as students transition into the nursing program and progressed through college.

Effective pain management and time to treatment is essential in patient care. Despite scientific evidence supporting the need to treat pain and an emphasis on addressing pain as a priority, pain management continues to be an unresolved issue. As a member of the health care team, nurses are integral to optimal pain management. Currently, nursing schools have limited innovative or alternative methods for teaching pain assessment and management. Simulation in nursing education provides a unique opportunity to expose students to realistic patient situations and allow them to learn and make mistakes without causing harm. However, modern low- and high-fidelity simulation technology is unable to display emotion, pain, or any facial expression. This limits training and education of conditions that may partially rely on the identification of symptoms based on the alteration of facial appearance, such as pain or stroke. This research explored student nurses’ perception of new technology that displayed computer-generated faces, each expressing varying degrees of physical expressions of pain. A total of 15 nursing students participated in the study. Students were asked to interpret the level of pain in four sequential faces using a numeric rating scale of 0-10, with 0 indicating no pain, and 10 the most severe pain possible. After scoring the faces, students were asked to answer four open-ended questions addressing the technology. Results of the study indicate a majority of nursing students believe the technology should be implemented into nursing curriculum and interacting with the projected faces was more beneficial than traditional teaching methods. Eventually, the potential for increased identification of conditions requiring observation of subtle facial changes will be explored.