Archived Continuing Education Articles in the AGH Library
March 2009
Record: 1
Title: 10 suggestions for orienting foreign-educated nurses: an
integrative review.
Authors: Robinson JE
Source: Journal for Nurses in Staff Development (J NURSES STAFF DEV), 2009
Mar-Apr; 25(2): 77-85 (22 ref)
Abstract: This article presents findings based on an integrative review of the
literature that spanned three topics: (a) nursing shortage, (b) foreign
nurses, and (c) immigration issues relating to foreign nurses. The author
offers 10 practical suggestions to clinical nursing educators facing the broad
array of challenges that occur when orienting foreign nurses immigrating to
the United States.
MEDLINE Info:PMID: 19346831 NLM UID: 9809908
Record: 2
Title: Acute pancreatitis and hypertriglyceridemia.
Authors: Lindberg DA
Source: Gastroenterology Nursing (GASTROENTEROL NURS), 2009 Mar-Apr; 32(2):
75-84 (17 ref)
Abstract: Pancreatitis is a condition characterized by painful inflammation of
the pancreas and can be either chronic or acute. The most common causes of
acute pancreatitis (AP) in the United States are gallstones and excessive
alcohol consumption. In addition, significantly elevated serum triglyceride
levels can precipitate episodes of AP. Genetic defects are associated with
severe elevations in serum triglyceride levels, whereas poorly controlled
diabetes, obesity, and high-fat diets can contribute to elevated triglyceride
levels substantial enough to provoke pancreatitis (secondary
hypertriglyceridemia). Treatment of hypertriglyceridemia-induced AP consists
of immediate reduction in serum triglyceride levels and long-term medications
and lifestyle modifications. Nurses are instrumental in patient education
about lifelong treatment strategies.
MEDLINE Info:PMID: 19357469 NLM UID: 8915377
Record: 3
Title: Battle plan for brain attacks.
Authors: Barker E
Source: RN (RN), 2009 Mar; 72(3): 30-6 (6 ref)
Abstract:New guidelines for aneurysmal subarachnoid hemorrhage focus on fast
actions and keen assessment skills.
MEDLINE Info:PMID: 19361059 NLM UID: 20010080R
Record: 4
Title: Beyond the basics: syncope.
Authors: Limmer DD; Mistovich JJ; Krost WS
Source: EMS Magazine (EMS MAG), 2009 Mar; 38(3): 76-81
Abstract: Whether in the hospital or prehospital environment, syncope is one of
the more perplexing diagnostic challenges facing clinicians. An understanding
of the pathophysiology behind syncope, common causes and diagnostically
significant examination items can lead to appropriate field decisions and
treatment.
MEDLINE Info:PMID: 19374114 NLM UID: 101466002
Record: 5
Title: CE connection. Helping kids grow.
Source: Nurse Practitioner (NURSE PRACT), 2009 Mar; 34(3): 41-2
MEDLINE Info:PMID: 19240636 NLM UID: 7603663
Record: 6
Title: CE connection. Warfarin therapy management: tap in to new ways
to slow the clot.
Source: Nurse Practitioner (NURSE PRACT), 2009 Mar; 34(3): 28-9
MEDLINE Info:PMID: 19240634 NLM UID: 7603663
Record: 7
Title: Competence and certification of registered nurses and safety of
patients in intensive care units.
Authors: Kendall-Gallagher D; Blegen MA
Source: American Journal of Critical Care (AM J CRIT CARE), 2009 Mar; 18(2):
106-14 (37 ref)
Abstract: Background Adverse events that place patients at risk for harm are
common in intensive care units. Clinicians' level of knowledge and judgment
appear to play a role in the prevention, mitigation, and creation of adverse
advents. Research suggests a possible association between nurses' specialty
certification and clinical expertise. The relationship between specialty
certification and clinical competence of registered nurses and safety of
patients is a relatively new area of inquiry in nursing. Objective To explore
the relationship between the proportion of certified staff nurses in a unit
and risk of harm to patients. Methods Hierarchical linear modeling was used in
a secondary data analysis of 48 intensive care units from a random sample of
29 hospitals to examine the relationships between unit certification rates,
organizational nursing characteristics (magnet status, staffing, education,
and experience), and rates of medication administration errors, falls, skin
breakdown, and 3 types of nosocomial infections. Medicare case mix index was
used to adjust for patient risk. Results Unit proportion of certified staff
registered nurses was inversely related to rate of falls, and total hours of
nursing care was positively related to medication administration errors. The
mean number of years of experience of registered nurses in the unit was
inversely related to frequency of urinary tract infections; however, the small
sample size requires that caution be exercised when interpreting results.
Conclusions Specialty certification and competence of registered nurses are
related to patients' safety. Further research on this relationship is needed.
MEDLINE Info:PMID: 19255100 NLM UID: 9211547
Record: 8
Title: Concept mapping: a road to critical thinking.
Authors: St. Cyr SK; All A
Source: Journal for Nurses in Staff Development (J NURSES STAFF DEV), 2009
Mar-Apr; 25(2): 70-6 (25 ref)
Abstract: Graduate nurses entering the workforce today are, at times, lacking
in the area of critical thinking. Giving graduate nurses a concept map would
provide a tool to guide their critical thinking until it becomes inherent or
second nature. The concept map, a graphic illustration of key points, guides
the focus of patient problems using a body system approach. This article
details the use of a concept map in the application of knowledge to practice.
MEDLINE Info:PMID: 19346829 NLM UID: 9809908
Record: 9
Title: Emergence delirium: a nursing perspective.
Authors: Hudek K
Source: AORN Journal (AORN J), 2009 Mar; 89(3): 509-20 (9 ref)
Abstract: Emergence delirium is a condition that can affect all segments of the
postoperative population, but is seen most often in pediatric and older adult
patients. Most cases of emergence delirium resolve quickly and without
incident; however, severe episodes may lead to increased incidence of injury
to both patients and staff members and increased costs. To minimize the
incidence of emergence delirium and treat it when it occurs, perioperative
nurses must be aware of the risk factors that contribute to this condition,
including the patient's age, type of anesthesia, anxiety level, level of
postoperative pain, and preexisting medical conditions. Copyright (c) AORN,
Inc, 2009.
MEDLINE Info:PMID: 19326585 NLM UID: 0372403
Record: 10
Title: External jugular cannulation in infants and children.
Authors: Pettit J
Source: Journal of Infusion Nursing (J INFUSION NURS), 2009 Mar-Apr; 32(2):
93-101 (13 ref)
Abstract: Placement of a peripherally inserted central catheter (PICC) is
commonplace in infants and children for the infusion of medications,
hydration, and nutritional solutions. Vein depletion caused by repeated and
prolonged need for vascular access devices has forced practitioners to
consider alternate veins for providing care. The external jugular vein has a
positive history of use for insertion of the PICC and is becoming increasing
popular for this purpose. Pertinent anatomy, patient selection criteria,
preparation, and catheter insertion and maintenance processes related to the
catheter placed and residing in the external jugular vein are discussed.
MEDLINE Info:PMID: 19289923 NLM UID: 101124170
Record: 11
Title: Focusing on the surgical patient with cardiac problems.
Authors: Morse KJ
Source: Nursing (NURSING), 2009 Mar; 39(3): 22-8 (2 ref)
Abstract: Learn about the latest guidelines for assessing cardiac risk and
protecting his heart during noncardiac surgery.
MEDLINE Info:PMID: 19247118 NLM UID: 7600137
Record: 12
Title: Formula for success: deliver enteral nutrition using best
practices.
Authors: Winkelman C; Best K
Source: American Nurse Today (AM NURSE TODAY), 2009 Mar; 4(3): 18-23 (5 ref)
Abstract: Between 30% and 50% of adults admitted to U.S. hospitals are
malnourished. This article explains how to provide nourishment while achieving
better outcomes and shorter hospital stays.
MEDLINE Info:NLM UID: 101291565
Record: 13
Title: Home assessment.
Authors: Fieldsmith R; Van Sell S; Kindred C
Editors: Raymond MK
Source: RN (RN), 2009 Mar; 72(3): 26-9 (11 ref)
MEDLINE Info:NLM UID: 20010080R
Record: 14
Title:Hypoxia in the term newborn: part one--cardiopulmonary
physiology and assessment... first of a three-part series.
Authors: Rohan AJ; Golombek SG
Source: MCN: The American Journal of Maternal Child Nursing (MCN), 2009
Mar-Apr; 34(2): 106-14 (17 ref)
Abstract: In this first of a three-part series on hypoxia in the term newborn,
the emphasis is on cardiopulmonary adaptation of the newborn. This article
includes definitions and features of neonatal hypoxia and reviews structural
abnormalities of the heart and great vessels, along with pulmonary
hypertension. During the transitional phase from intrauterine to extrauterine
life, newborn infants require close monitoring in order to recognize and
address abnormalities in adaptation. The evaluation of the hypoxic infant is
one of the most common problems for the pediatric clinician; although there
are several common causes for newborn cyanosis, myriad disorders spanning all
organ systems exist as possibilities etiologies. Knowledge of the breadth of
feasible diagnoses and a systematic approach to the assessment of these term
newborns are essential for accurate diagnosis, treatment, and referral.
MEDLINE Info:PMID: 19262264 NLM UID: 7605941
Record: 15
Title: Interrater variability of a severity-of-illness score in
critically ill adults.
Authors: Miller AD; Branson P; Winstead PS; Hiestand DM
Source:A merican Journal of Critical Care (AM J CRIT CARE), 2009 Mar; 18(2):
118-23 (7 ref)
Abstract: Background Critically ill patients often require sedation and
analgesia. Scales have been developed to provide clinicians with sedation
targets. Daily interruption of continuous infusions of sedatives and sedation
protocols improve patients' outcomes. However, perceived instability of a
patient's condition can prevent implementation of appropriate sedation targets
and daily interruption of sedation. Objective To evaluate the interrater
variability of a severity-of-illness score developed to help nurses determine
patient-specific sedation targets and identify candidates for daily
interruption of sedation. Methods The severity-of-illness score was
implemented as part of an institutional protocol, and bedside nurses in the
medical intensive care unit were taught how to determine and use the score.
Bedside nurses recorded the score daily in patients' medical records. For
study purposes, a study nurse who made rounds with the medical team and a
pulmonary/critical care fellow physician also independently determined the
score. Results A total of 38 assessments of severity-of-illness scores in 10
different patients were made during the study period. For the 24 assessments
made by all 3 observers, the {kappa} coefficient for agreement for the
severity-of-illness score was 0.58. Conclusions The severity-of-illness score
had good interrater variability as a tool for determining sedation targets and
identifying candidates for daily interruption of sedation. Future study on how
use of the score affects sedative dosing and outcomes is needed.
MEDLINE Info:PMID: 19255101 NLM UID: 9211547
Record: 16
Title: Introduction to stem cell therapy.
Authors:Biehl JK; Russell B
Source:J ournal of Cardiovascular Nursing (J CARDIOVASC NURS), 2009 Mar-Apr;
24(2): 98-105 (28 ref)
Abstract: Stem cells have the ability to differentiate into specific cell
types. The 2 defining characteristics of a stem cell are perpetual
self-renewal and the ability to differentiate into a specialized adult cell
type. There are 2 major classes of stem cells: pluripotent cells, which can
become any cell in the adult body, and multipotent cells, which are restricted
to becoming a more limited population of cells. Cell sources, characteristics,
differentiation, and therapeutic applications are discussed. Stem cells have
great potential in tissue regeneration and repair, but much still needs to be
learned about their biology, manipulation, and safety before their full
therapeutic potential can be achieved.
MEDLINE Info:PMID: 19242274 NLM UID: 8703516
Record: 17
Title: Issues in pediatric immunization.
Authors: Sharts-Hopko NC
Source: MCN: The American Journal of Maternal Child Nursing (MCN), 2009
Mar-Apr; 34(2): 80-90 (35 ref)
Abstract: Revisions to the Centers for Disease Control and Prevention's
pediatric immunization guidelines have generated a renewed focus on
controversies associated with the nation's childhood vaccination program.
Among these issues are adherence with and access to required vaccinations,
concerns about individuals' rights in relation to government-mandated
vaccinations, ongoing worry about adverse effects associated with
immunizations, and questions about how best to protect immunocompromised and
ill children. This article addresses these questions and presents strategies
that can be used by clinicians to improve adherence with vaccination
guidelines.
MEDLINE Info:PMID: 19262260 NLM UID: 7605941
Record: 18
Title: Long-term survival in the intensive care unit after
erythrocyte blood transfusion.
Authors:Engoren M; Arslanian-Engoren C
Source:A merican Journal of Critical Care (AM J CRIT CARE), 2009 Mar; 18(2):
124-32 (24 ref)
Abstract: Background Erythrocyte blood transfusions are commonly used in
intensive care units, yet little is known about their effects on long-term
survival. Objective To determine the effect of erythrocyte blood transfusion
in intensive care units on long-term survival. Methods Retrospective analysis
of a prospectively collected database of 2213 patients admitted January 27,
2001, to April 30, 2002, to the cardiac, burn, neurological-neurosurgical, and
combined medical-surgical intensive care units in a tertiary care,
university-affiliated, urban medical center. Further analysis was done on a
case-control subgroup (n = 556) formed by matching scores on the Acute
Physiology and Chronic Health Evaluation (APACHE) II and propensity scores.
Results Although transfusion was univariably associated with increased risk of
death at all 3 times (0-30, 31-180, and >180 days after admission to the
unit), multivariable adjustment with Cox modeling showed that transfusion had
no association with mortality for the first 2 intervals (0-30 and 31-180
days), but was associated with a 25% lower risk of death (hazard ratio, 0.75;
95% confidence interval, 0.57-0.99; P = .04) in patients who survived at least
180 days after admission to the unit. In the case-control patients, after
correction for APACHE II risk of death and propensity to receive a
transfusion, transfusion had no association with mortality for the first 2
intervals, but was associated with 29% lowered risk of death (hazard ratio,
0.71; 95% confidence interval, 0.50-0.99; P=.046). Conclusion Blood
transfusion was associated with a decreased risk of late (>180 days) death in
intensive care patients.
MEDLINE Info:PMID: 19255102 NLM UID: 9211547
Record: 19
Title: Nursing strategy: What's your plan?
Authors: Conway-Morana PL
Source: Nursing Management (NURS MANAGE), 2009 Mar; 40(3): 25-30 (9 ref)
Abstract: Define all mechanisms by which nurses meet their department's mission
and those of the organization, overall.
MEDLINE Info:NLM UID: 8219243
Record: 20
Title: Prevention of pressure ulcers in the surgical patient.
Authors: Walton-Geer PS
Source: AORN Journal (AORN J), 2009 Mar; 89(3): 538-52 (28 ref)
Abstract: Pressure ulcers (PUs) are a serious health care problem, and it is
crucial to assess how patients acquire pressure ulcers after admission to a
health care facility. In the OR, factors related to positioning, anesthesia,
and the duration of surgery, in addition to patient-related factors, all can
affect PU development. This article reviews current practices, including AORN
recommended practices, regarding pressure ulcer prevention efforts for
surgical patients. All surgical patients should be considered at-risk for
pressure ulcer development; therefore, perioperative departments should
develop and implement strategic plans for pressure ulcer prevention. AORN J 89
(March 2009) 538-548. (c) AORN, Inc, 2009.
MEDLINE Info:PMID: 19269379 NLM UID: 0372403
Record: 21
Title: Probation and recidivism: remediation among disciplined nurses
in six States.
Authors: Zhong EH; Kenward K; Sheets VR; Doherty ME; Gross L
Source: American Journal of Nursing (AM J NURS), 2009 Mar; 109(3): 48-50, 52-8
(15 ref)
Abstract: OBJECTIVE: The researchers sought to determine what factors might
affect the outcomes of remediation, including the likelihood of recidivism,
among nurses who had been the subject of disciplinary action and had been put
on probation by a state board of nursing. METHODS: Boards of nursing in six
states, Arizona, Maryland, Massachusetts, Minnesota, Nebraska, and North
Carolina, chose to participate in this exploratory study. A 29-item
questionnaire was used to investigate the records of 207 RNs, LPNs, and
advanced practice RNs (APRNs) who were disciplined and put on probation by a
state nursing board in 2001, as well as to collect data on their employment
settings, the boards' actions, and remediation outcomes (the presence or
absence of recidivism); 491 nurses who had not been disciplined served as
controls. RESULTS: Among the disciplined nurses studied, 57% were RNs, 36%
were LPNs, 3% held both RN and LPN licenses, and 3% were APRNs. Of the
disciplined group, 39% recidivated between 2001 and 2005. Three factors were
shown to influence the recidivism rate: having a history of criminal
conviction, having committed more than one violation before the 2001
probation, and changing employers during the probationary period.Data on
history of criminal conviction prior to state board disciplinary action were
available for 112 (54%) of the 207 nurses. Among those 112, 35% (n = 39) had a
history of criminal conviction, whereas only 3% of the control group reported
one. The recidivism rate among those with a history of criminal conviction
(56%; 22 of 39 nurses) was nearly twice as high as the rate among those
without such a history (33%; 24 of 73). Also, 33% of the disciplined nurses
changed employers during their probation; the recidivism rate among them was
more than twice the rate among the disciplined nurses who stayed with the same
employer. The recidivism rate of the 45 disciplined nurses who committed more
than one practice-related violation from 1996 through 2001 was twice as high
as the rate of those who committed only a single violation.The proportion of
men who had been disciplined was more than twice the proportion of men in the
national nursing workforce. Younger nurses (both men and women) were more
likely to recidivate. CONCLUSIONS: All health care regulators and nursing
employers should be aware of the association between a history of criminal
conviction and the likelihood of committing a violation that requires state
nursing board disciplinary action.
MEDLINE Info:PMID: 19240497 NLM UID: 0372646
Record: 22
Title: Recognizing & responding to acute liver failure.
Authors: McKinley M
Source: Nursing (NURSING), 2009 Mar; 39(3): 38-45 (11 ref)
Abstract: By quickly recognizing the signs and symptoms of acute liver failure,
you can help your patient improve his odds of surviving this often-deadly
condition.
MEDLINE Info:PMID: 19247124 NLM UID: 7600137
Record: 23
Title: Recognizing and preventing refeeding syndrome.
Authors: Adkins SM
Source: Dimensions of Critical Care Nursing (DCCN), 2009 Mar-Apr; 28(2): 53-60
(29 ref)
Abstract: Refeeding syndrome is an uncommon but potentially fatal phenomenon
that can occur in patients receiving parenteral, enteral, or oral feedings
after a period of sustained malnutrition or starvation. This syndrome is
characterized by hypophosphatemia, hypokalemia, and hypomagnesemia. The
purpose of this article was to bring an acute awareness of refeeding syndrome
to the critical care nurse. The recognition, pathogenesis, clinical
manifestations, potential life threatening complications, and treatment are
presented.
MEDLINE Info:PMID: 19225312 NLM UID: 8211489
Record: 24
Title: Recognizing sepsis in the adult patient.
Authors: Nelson DP; LeMaster TH; Plost GN; Zahner ML
Source: American Journal of Nursing (AM J NURS), 2009 Mar; 109(3): 40-6 (7 ref)
Abstract: Patients in every health care setting are at risk for systemic
inflammatory response syndrome, sepsis, severe sepsis, and even septic shock.
The increasing incidence of sepsis, especially among older adults, its high
mortality rate, and its subtle and rapid progression make prompt recognition
and treatment imperative. Even though severe sepsis requires treatment in the
ICU, the assessment of sepsis isn't solely the domain of the physician,
critical care nurse, or ED nurse. Improving outcomes in patients with sepsis
depends on every nurse involved in their care. The case study presented here
is of a nursing home resident with unrecognized sepsis that progresses to
severe sepsis-at which point not even seven days' treatment in the ICU could
halt the progression to multiple organ failure.
MEDLINE Info:PMID: 19240494 NLM UID: 0372646
Record: 25
Title: Superior mesenteric vein thrombosis after bowel resection in
patients with inflammatory bowel disease.
Authors: McCutcheon T
Source: Gastroenterology Nursing (GASTROENTEROL NURS), 2009 Mar-Apr; 32(2):
85-93 (16 ref)
Abstract: Superior mesenteric vein thrombosis is one of many causes of
mesenteric ischemia and may occur after intestinal surgery in patients with
inflammatory bowel disease. While hypercoagulability is a known complication
of inflammatory bowel disease, other risk factors may also coexist and play a
role in the development of superior mesenteric vein thrombosis. The true
etiology of hypercoagulability that seems to be present in the face of
inflammatory bowel disease is unknown but thought to be related to multiple
factors including vitamin deficiency, the inflammatory process, prothrombotic
conditions, hypercoagulable states, and other abnormalities of coagulation.
Symptoms of superior mesenteric vein thrombosis are often vague, leading to a
delay in diagnosis, increasing not only the mortality rate but also the need
for surgical intervention rather than medical management. Once diagnosed,
patients are managed with anticoagulation alone or in combination with
surgical intervention. Most patients improve and will continue anticoagulation
therapy ranging from 3 months to lifelong treatment, depending on the origin
of the hypercoagulable state and the extent of condition.
MEDLINE Info:PMID: 19357471 NLM UID: 8915377
