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This study's purpose was to describe the practice patterns of nurse practitioners (NPs) in Tennessee--specifically, the demographic characteristics and health problems of their clients and the therapeutic services they provide. A random sample of NPs practicing 20 or more hours per week in primary care in Tennessee provided data on a total of 680 clients seen during one selected day of care. An instrument adapted from the National Ambulatory Medical Care Survey (NAMCS) allowed comparison of the NP findings with a national survey of office-based physicians in five areas: client demographics, client health status, diagnostic tests ordered, therapeutic interventions provided, and client disposition. Although many similarities were seen, differences included the tendency of NPs to care for more younger and female clients, to perform fewer office surgical procedures, and to provide more health teaching/counseling interventions.

Like your average morning alarm, hospital alarms are specifically designed to elicit cognitive distress via auditory stimulation. They sound continuously, beckoning hospital staff to investigate the source of their call, day and night. As a result, caregivers become desensitized and begin to ignore the seemingly constant stimulus. However, ignoring these pleas for help can lead to adverse patient outcomes as the true alarms are indistinguishable from the false. In this study, we will review literature from the last five years to examine how alarm fatigue in nurses leads to detrimental patient outcomes and how we can begin to reduce the incidence of alarm fatigue. For example, when telemetry leads are improperly applied or lose their adherence, they are more sensitive to patient movements and can cause alterations on the recorded cardiac strips, creating the illusion that a patient is having an arrhythmia when, in reality, the patient is fine. This phenomenon causes alarms to chime, requiring the nurse to rush into the room to check on the patient and turn off the alarm. This can occur multiple times a shift, causing the nurse to become overwhelmed, to ignore the alarm, or to become distracted from their other duties due to the constant alarm response. This situation can easily be avoided by proper preparation of skin at the attachment site and the replacement of leads and pulse oximeters with disposable versions that can be changed daily. The aim of this study is to provide a multifaceted approach to identify ways to reduce the amount of alarm fatigue in an acute care setting in order to improve patient outcomes and consequently increase both patient and nurse satisfaction.

Background: Antibiotic stewardship (ABS) is a set of strategies to optimize the use of antibiotics with the goal of reducing antibiotic resistance, improving patient outcomes and decreasing unnecessary costs. ABS affects all venues of patient care, including outpatient, inpatient, and long-term care. While many strategies for ABS exist and best practice continues to evolve, successful ABS programs utilize a multidisciplinary approach. Nurse practitioners (NPs) play an essential role in health care education and represent a valuable potential resource for ABS efforts. The purpose of this study is to describe the knowledge, attitudes, and perceptions of NPs towards ABS.Methods: A convenience sample of NPs attending the American Association of Nurse Practitioners annual conference was given a modified descriptive survey developed for use in a previous study conducted at a university-affiliated hospital in Florida. Descriptive statistics were used to assess normality. Chi-Square test of independence was used to test differences categorical scores by NP setting, gender, and level of education. Pearson r correlation was completed to measure the relationship between age and years in practice.Results: Two hundred NPs completed the questionnaire (88% female; 70% Master’s degree). The range of experience was 0-45 years (mean 11 years). Most NPs worked in a private office (23%) or community setting (29%). Factors affecting the decisions of antibiotic prescriptions included patient condition (79%) and patient cost (58%). NPs in this study also based their antibiotic decisions on the antibiogram (63%) in their setting, while 56% indicated they start with broad spectrum and tailor antibiotic choices when culture results are received. NPs reported understanding that inappropriate use of antibiotics causes resistance (97%), harms the patient (97%), and optimum antibiotic use will reduce resistance (94%). Participants also recognized that strong knowledge of antibiotics was important for their job (94%) and felt confident in their use of antibiotics (86%). However, while 94% of respondents somewhat or strongly agreed that antibiotics are overused nationally, only 62% thought antibiotics were overused in their health care setting. Conclusion: In this study, most NPs reported that antibiotic resistance is a problem and antibiotics are overused nationally. Fewer believe that antibiotic resistance is a problem locally and fewer still that they, personally, contribute to the problem. NPs recognize that knowledge about antibiotics is important to their career and would like more education about antibiotics and feedback about their antibiotic choices. Finding effective ways to provide this education could change practice and improve antibiotic use.

Background: Studies show that when nurses are experiencing problems in the care of non-Swedish speaking patients, it is often due to obstacles in the communication. Studies also show that a prerequisite for adequate care is that there is a basis for a direct communication. Nurses perceive interpreters as an important link to the patient when they do not share a mutual language, the nurses perceive interpreters as a bridge in the conversation. Aim: The purpose of the study is to describe nurses' experiences of the quality of assessments done with the help of an interpreter. Method: The study was conducted through interviews with ten nurses, working at psychiatric clinics. Qualitative content analysis was used for the analysis, which resulted in five categories. Results: The analysis resulted in one theme: "it´s the interpreter who tells me and have not the feeling that the patient has" and five categories: "shades of the language", "conversation structure", "the interpreter's competence", "interpreting implementing" and "the interpreter's gender and origin". The nurses experience working with interpreters as a challenge. The difficulty of working with the help of an interpreter is that the nurse cannot see the spoken word in connection with the patient's body language. Communication through an interpreter also felt unnatural and the interpreter's participation is perceived as a filter. Conclusion: The quality of the assessments were not perceived as good with the interpreter as without, however, there was no risk to patient safety.

Older adults living with frailty have increased healthcare needs, but require accurate identification for optimal care; nurses’ screening practice is unclear. This cross-sectional survey explored nurses’ frailty screening practices and barriers/facilitators in acute care. Descriptive statistics were generated from 5-point frequency and 101-point scales of frailty screening methods; practice areas were compared using linear regression. Means for barriers and facilitators were generated from a 43-item 6-point Likert-type Theoretical Domains Framework questionnaire. Respondents (n = 228) reported “usually” screening by clinical impression (median = 4, interquartile range = 4-5) and preferring it to formal frailty tools (M = 67.1, SD = 25.7). Practice area influenced general frailty screening (B = 0.81, r = .31, p < .001). The top barrier was belief conducting frailty screening was routine (M = 2.68, SD = 1.42, p > .05). Frailty screening tools supporting clinical judgement and embedded into routine have greater likelihood for uptake.

Meeting patient expectations in relation to pain management is an essential component of palliative and end-of-life care. However, previous research has demonstrated that pain is highly prevalent, especially during the four months prior to death. Poorly controlled pain contributes to cognitive failure, depression and an inability to complete daily activities. Unfortunately, pain and symptom management are often inadequate for patients placed in hospice care. The purpose of this study is to evaluate the perspectives of hospice nurses on complementary and alternative therapies to determine if there is an educational need in order to aide in the management of chronic pain in older adults. A survey was developed in order to determine the nursing perceptions of complementary and alternative therapies. A total of 24 participants were recruited. The survey targeted 28 complementary and alternative therapies most commonly used as defined by National Institute for Complementary and Alternative Medicines (NCCAM). Each therapy was ranked on several aspects including perceptions, personal experience, and present knowledge and training. After completing the survey it was found that all participants were either eager or open to use some complementary and alternative therapies in their workplace, in spite of having an educational barrier on how to implement them, and wanted these therapies to become available to patients, families, and staff.

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