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Title: EVALUATION OF A SIMULATION-ENHANCED OBSTETRIC CLINICAL EXPERIENCE ON LEARNING OUTCOMES FOR KNOWLEDGE, SELF-EFFICACY, AND TRANSFER.
Creator: Guimond, Mary, Sole, Mary Lou, University of Central Florida
Abstract / Description: Simulation using computerized patient mannequins may be a useful mechanism to teach safe and effective nursing care, thus improving the quality of education for nurses. As nursing program enrollments grow, clinical placement is becoming more difficult and may not offer consistent learning opportunities that reinforce safe and effective nursing practice. This study applied Ford, Smith, Weissbein, Gully, and SalasÃÂÃÂÃÂÃÂ' (1998) model of learning transfer as the theoretical framework to...
Show moreSimulation using computerized patient mannequins may be a useful mechanism to teach safe and effective nursing care, thus improving the quality of education for nurses. As nursing program enrollments grow, clinical placement is becoming more difficult and may not offer consistent learning opportunities that reinforce safe and effective nursing practice. This study applied Ford, Smith, Weissbein, Gully, and SalasÃƒÂƒÃ‚Â‚ÃƒÂ‚Ã‚Â' (1998) model of learning transfer as the theoretical framework to design a simulated obstetric clinical learning experience to augment the current clinical practice model, an approach that may lead to an improved educational experience. The purpose of this study was to compare learning outcomes of two clinical teaching strategies for obstetric clinical content for undergraduate nursing students: standard clinical instruction and a simulation-enhanced clinical experience. A mixed-method approach was used. A randomized cluster design was chosen to compare the learning outcomes for students participating in a simulation-enhanced clinical experience versus students participating in a traditional clinical rotation. From the study population of 124 students, 40 participated in the simulation-enhanced clinical group, with the remainder of students serving as controls. Four instruments (Obstetric Nursing Self-Efficacy instrument, Goal Orientation Scale, Proxy Measure, and examination knowledge items) were used to measure student characteristics or achievement of outcomes. Learning outcomes for self-efficacy, knowledge, skills, and transfer were compared between the groups using ANCOVA, independent sample t-test, and chi-square analyses. A qualitative descriptive analysis of clinical evaluations for all students was also conducted. Demographic characteristics between the groups were not statistically different. The analysis of covariance (ANCOVA) revealed no difference in ONSE posttest scores between the groups after adjusting for goal orientation and ONSE pretest scores. An alternative ANCOVA for sequence (time in semester when the simulation occurred) and group was not significant. However, after adjustment for the covariate of ONSE pretest scores, ONSE posttest scores varied with sequencing (p <.05); students who had the simulated experience during the first half of the semester (M=67.27) scored higher than those in the second half (M=60.89) when pretest scores were used as a covariate. No differences were found between the experimental and control groups for knowledge or skills. The narrative analysis revealed broad variation in comments on the clinical evaluation form among clinical instructors. Attitude, knowledge attainment, skill acquisition, helpfulness, and professional role attributes were common themes related to student clinical performance. The findings from the study contribute to a growing body of literature evaluating the efficacy of simulation to augment clinical nursing practice experience. Data suggest there is little difference in learning outcomes for students participating in a simulation-enhanced clinical group versus the traditional clinical rotation. This finding supports that at least 15% of clinical hours could occur in a simulated clinical environment. A model driven method of simulation design and delivery could support learning in a way that will allow for efficient and effective use of simulation to support safe and effective obstetric nursing care.
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Date Issued: 2010
Identifier: CFE0003414, ucf:48374
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0003414

Title: EFFECTIVENESS OF SUBGLOTTIC SUCTIONING IN THE PREVENTION OF VENTILATOR ASSOCIATED PNEUMONIA.
Creator: Amato, Cody, Sole, Mary Lou, University of Central Florida
Abstract / Description: Ventilator-associated pneumonia (VAP) is the leading healthcare-acquired infection among ventilated patients in intensive care units (ICU). VAP is a serious patient complication that results in increased hospital length of stay, cost, morbidity, and mortality. The accumulation of subglottic secretions above the endotracheal tube (ETT) cuff increases the risk of VAP, as these secretions may leak around the cuff of the ETT resulting in aspiration and an increased risk for infection. An in depth...
Show moreVentilator-associated pneumonia (VAP) is the leading healthcare-acquired infection among ventilated patients in intensive care units (ICU). VAP is a serious patient complication that results in increased hospital length of stay, cost, morbidity, and mortality. The accumulation of subglottic secretions above the endotracheal tube (ETT) cuff increases the risk of VAP, as these secretions may leak around the cuff of the ETT resulting in aspiration and an increased risk for infection. An in depth literature review was done to determine the effectiveness of subglottic secretion aspiration (by means of specialized ETT tubes with intrinsic suction lumens) in decreasing the incidence rate of VAP. Evidenced-based data were gathered from the CINAHL Plus with Full Text, PubMed, and Cochrane Database of Systematic Reviews databases for this review. VAP guidelines recommend subglottic secretion aspiration as a means to prevent its occurrence. However, important variables such as suction pressure, frequency, secretion viscosity, and ETT cuff pressure and volume need to be considered. The interaction among these variables determines the effectiveness of subglottic secretion removal. The goal of this review was to highlight these interactions and provide evidenced-based information for critical care nurses to expand their understanding of the dynamics involved in subglottic secretion aspiration and how to efficiently use this practice to prevent VAP.
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Date Issued: 2011
Identifier: CFH0003810, ucf:44775
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFH0003810

Title: EVALUATION OF AN EDUCATIONAL INTERVENTION FOR THE STAFF ON THE HEAD OF THE BED ELEVATION IN THE PEDIATRIC INTENSIVE CARE UNIT.
Creator: Johnson, Randall, Sole, Mary Lou, University of Central Florida
Abstract / Description: Elevating the head of bed (HOB) reduces risks for aspiration and ventilator associated pneumonia (VAP) in the adult population. Educational interventions have resulted in improvements in achieving a target HOB elevation of 30° in adults. Limited research has addressed this intervention in the pediatric intensive care unit (PICU). The aim of this study was to determine if an educational intervention for the PICU staff would result in improvement in the HOB elevation in the PICU. Four...
Show moreElevating the head of bed (HOB) reduces risks for aspiration and ventilator associated pneumonia (VAP) in the adult population. Educational interventions have resulted in improvements in achieving a target HOB elevation of 30° in adults. Limited research has addressed this intervention in the pediatric intensive care unit (PICU). The aim of this study was to determine if an educational intervention for the PICU staff would result in improvement in the HOB elevation in the PICU. Four research questions were studied: 1) What is the common practice related to the elevation of the HOB in the PICU? 2) Is there a difference in the mean HOB elevation before and after an education intervention? 3) Is there a difference in the percent of time the HOB is at or above 30° after the intervention? and 4) What factors influence HOB elevation in the PICU? A quasi-experimental, pre, and post measurement, with nonequivalent comparison group design was used. The angle of the HOB elevation was measured with the "Pitch and Angle Locator" (PAL) (Johnson, Mequon, WI). Baseline measurements (n = 99) were obtained for patients admitted to a PICU at various days and times over a 2-week period. An educational intervention was done for the staff members in the PICU, with a focus on the importance of keeping the HOB up and strategies for measuring the HOB elevation. Posters to reinforce the information were placed on the unit. Post-intervention, measurements (n = 98) were obtained for another 2-week period. At the time of data collection, staff members caring for the PICU patients were asked to provide responses for what influenced them to place the patient at the documented HOB elevation. Children were older in the post-intervention group than in the pre-intervention (8.8 yrs, vs. 3.7, yrs, respectively, t = -6.67, df = 195, p= .000). The children also weighed more in the post-intervention group than in the pre-intervention (32.0 kg vs. 19.7 kg, respectively, t = -4.19, df= 195, p = .000). The mean HOB elevation was 23.5° before the intervention. After the intervention, the mean HOB increased to 26.5° (t = -1.19, df 195, p = .033). For ventilated patients, the mean HOB elevation went from 23.6° to 29.1° (t = -3.25, df 95, p= .001), and for patients mechanically ventilated and in an adult bed, the mean increased from 26° ± 7.89°, pre- intervention to 30° ± 8.59° post-intervention (t = -1.80, df 63, p = .038). The percent of the time the measures were greater than 30° increased from 26% to 44% pre- and post-intervention respectively (χ2 6.71, df 1, p= .005). Responses (n = 230) related to the factors that influenced positioning were categorized as follows: physician order (3%), safety (7%), found this way (11%), therapeutic intervention (16%), comfort (24%), and patient condition (39%). An educational intervention can impact the practice of elevation of the HOB in a PICU, thus decreasing the risks of developing aspiration and VAP. Although the mean HOB increased statistically, the HOB was less than 30° in more than half of the post intervention measurements, indicating the need for ongoing reinforcement of the education. The PAL device was a new, reliable method for recording HOB elevation in both adult beds and cribs. Follow-up research is needed to determine if these gains in HOB elevation have been sustained over time and their impact on VAP.
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Date Issued: 2007
Identifier: CFE0001796, ucf:47287
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0001796

Title: COHORT STUDY OF PAIN BEHAVIORS IN THE ELDERLY RESIDING IN SKILLED NURSING CARE.
Creator: Burfield, Allison, Sole, Mary Lou, University of Central Florida
Abstract / Description: An integral concern across care settings is the prompt intervention for patients suffering with pain. Long-term care (LTC) settings present with unique challenges to assess and manage pain in resident populations. Pain assessment is especially challenging, because residents have varying degrees of cognition to communicate their pain, and clinician/staff knowledge of pain symptoms may be lacking. The purpose of this research was to improve the measurement of pain and outcomes of care for the...
Show moreAn integral concern across care settings is the prompt intervention for patients suffering with pain. Long-term care (LTC) settings present with unique challenges to assess and manage pain in resident populations. Pain assessment is especially challenging, because residents have varying degrees of cognition to communicate their pain, and clinician/staff knowledge of pain symptoms may be lacking. The purpose of this research was to improve the measurement of pain and outcomes of care for the elderly residing in skilled nursing care, especially those with cognitive-impairment. The specific aims of this study were to: 1) Determine the magnitude of the relationship between pain behaviors and a measurement model hypothesized for pain; 2) Test the construct validity of a pain measurement model; 3) Examine the concomitance of pain and cognition in a three-year longitudinal analysis. The research questions answered: 1) Is there a difference in the prevalence of pain in cognitively intact versus cognitively-impaired residents; 2) Can a theoretically derived model of pain aid in detecting pain across all cognitive levels; and 3) Do pain and cognitive status concomitantly correlate? The goal was to examine the covariance model of concomitance of pain and cognition to more accurately construct theoretical models of pain to then include additional resident care factors in future research. Traditional self-reports of pain are often under-assessed and under-treated in the cognitively-impaired (CI) elderly resident. Having additional measures to detect pain beyond self-reports of pain intensity and frequency increases the likelihood of detecting pain in populations with complex symptom presentation. Data collected from skilled nursing facilities offer exceptional opportunities to study resident demographics, characteristics, symptoms, medication use, quality indicators, and care outcomes. The Minimum Data Set-Resident Assessment Instrument (MDS-RAI) 2.0, a nationally required resident assessment tool, must be completed on every resident in a Medicare LTC facility within 14 days of admission, quarterly, annually and with significant changes in resident status. Because the MDS is widely used and recognized in LTC settings, core items from MDS [i.e., pain frequency (J2a) and pain intensity (J2b)] along with additional MDS items hypothesized to signify pain were analyzed in the pilot measurement model. Ten core items from MDS were used: 1) Inappropriate behavior frequency (E4da); 2) Repetitive physical movements; 3) Repetitive verbalizations (E1c); 4) Sad facial expressions (E1l); 5) Crying (E1m); 6) Change in mood (E3); 7) Negative statements (E1a); 8) Pain frequency (J2a); 9) Pain intensity (J2b); and 10) Cumulative pain sites scores. All indicators of pain were significant at the p<.01 level. A longitudinal cohort design was used to answer if a concomitance exists between pain and cognition. Data were collected from MDS annual assessments from 2001, 2002 and 2003 for residents across the United States. The sample consisted of 56,494 residents age 65 years and older with an average age of 83 ±8.2 years. Descriptive statistics, ANOVA and a covariance model were used to evaluate cognition and pain at the three time intervals. ANOVA indicated a significant effect (p<.01) for pain and cognition with protected t-tests indicating scores decreased significantly over time with resident measures of pain and cognition. Results from this study suggest that: 1) Using only pain intensity and frequency, pain prevalence was found in 30% of the pilot population, while 47.7% of cognitively intact residents had documented pain and only 18.2% of the severely CI had documented pain, supporting previous research that pain is potentially under-reported in the CI; 2) Parsimonious measurements models of pain should include dimensions beyond self-reports of pain (i.e., cognitive, affective, behavioral and inferred pain indicators); 3) Model fit was improved by using specific MDS items in the pain construct; 4) Longitudinal analysis revealed relative stability for pain and cognition measures over time (e.g., larger stability or consistency was found in cognitive measures than the measures of pain over the three-year period); 5) Crossed-legged effects between pain and cognition were not consistent; 6) A concomitant relationship was not found between pain and cognition. The relationship was significant (p<.01), but associations were weak (r=0.03 to 0. 08). Pain or cognition should not be used as a predictor of the other in theoretical models for similar populations. The MDS is a reliable instrument to follow resident attributes, quality of care, and patient outcomes over time. The development of more accurate assessments of pain may improve resident care outcomes. Ineffectively intervening on the pain cycle is posited to cause secondary unmet needs that affect the resident's quality of life. Findings support the importance of improving clinical outcomes in the management of pain in the elderly residing in long-term care. Deficits in the treatment of pain highlight the impetus to support health policy change that includes pain treatment as a top health priority and a quality indicator for federally funded programs supporting eldercare.
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Date Issued: 2009
Identifier: CFE0002533, ucf:47660
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0002533

Title: ASSESSMENT OF TRACHEOSTOMY CARE PRACTICES IN A SIMULATED SETTING.
Creator: Bolsega, Thomas, Sole, Mary Lou, University of Central Florida
Abstract / Description: Background: Although a tracheostomy is a common procedure for patients who require prolonged mechanical ventilation, little evidence exists as to the best practices for performing tracheostomy care to maintain the airway and promote skin integrity. Therefore, variability is likely, which may negatively impact patient outcomes. This study described tracheostomy care practices of registered nurses (RNs) and respiratory therapists (RTs) who regularly perform tracheostomy care in critical care...
Show moreBackground: Although a tracheostomy is a common procedure for patients who require prolonged mechanical ventilation, little evidence exists as to the best practices for performing tracheostomy care to maintain the airway and promote skin integrity. Therefore, variability is likely, which may negatively impact patient outcomes. This study described tracheostomy care practices of registered nurses (RNs) and respiratory therapists (RTs) who regularly perform tracheostomy care in critical care settings. Methodology: The descriptive study was conducted following informed consent. RNs (n=15) and RTs (n=5) were asked to perform tracheostomy care on a simulated mannequin patient. An array of supplies (both required and not necessary) was available to perform tracheostomy care. The procedure was video-recorded and the researchers also used an observation checklist. Equipment used and steps performed were compared to hospital policy and the American Association of Critical-Care Nurses (AACN) Procedure Manual. Data were analyzed with descriptive statistics. Results: The majority (80%) of participants were female and held a baccalaureate degree; median experience was 5 years. Equipment selection varied widely; supplies used by 50% or more of participants included non-sterile gloves, hydrogen peroxide, cotton swabs, disposable cannula, foam ties, and gauze dressings. The order of steps was variable with unique differences noted among all participants. The most common sequence was hand hygiene, clean flange, clean stoma, change inner cannula, change ties, and apply dressing. No one performed in the order recommended in the AACN Procedure Manual. Wide variability in practices emphasizes the need for establishing an evidence-based approach for performing tracheostomy care. Discussion: Research supported the belief that variation to technique and supplies does exist when performing tracheostomy care. Tracheostomy varied from provider to provider within one hospital unit, demonstrating the need for further research and protocols for tracheostomy care. Education on existing protocols and evidence-based practice should be conducted to ensure that providers are following unit protocols.
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Date Issued: 2015
Identifier: CFH0004746, ucf:45359
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFH0004746

Title: MUSIC THERAPY AS AN INTERVENTION TO REDUCE ANXIETY IN MECHANICALLY-VENTILATED PATIENTS.
Creator: Levine, Stephanie L, Sole, Mary Lou, University of Central Florida
Abstract / Description: Patients receiving mechanical ventilation endure high levels of stress and anxiety due to the invasiveness of the procedure. These critically ill patients are often uncomfortable as a result of their serious conditions and the high-intensity environments in which they are placed. Health care workers heavily sedate these patients to minimize pain and induce a state of relaxation. However, sedatives are known for their wide-ranging, and often deleterious, side effects. Music therapy is an...
Show morePatients receiving mechanical ventilation endure high levels of stress and anxiety due to the invasiveness of the procedure. These critically ill patients are often uncomfortable as a result of their serious conditions and the high-intensity environments in which they are placed. Health care workers heavily sedate these patients to minimize pain and induce a state of relaxation. However, sedatives are known for their wide-ranging, and often deleterious, side effects. Music therapy is an intervention that has been studied in a variety of hospital settings to determine any potential beneficial effects on patients. Many studies have demonstrated a relationship between music therapy and decreased anxiety levels. This thesis reviewed studies on outcomes of music therapy on anxiety in mechanically-ventilated patients. A total of 10 studies that addressed the use of music to decrease anxiety in ventilated patients were analyzed and incorporated into the literature review. The articles were selected from a variety of databases on EBSCOhost, including MEDLINE, PsycINFO, ScienceDirect, and CINAHL. The literature review provides positive evidence for the support of music therapy to help alleviate anxiety in mechanically-ventilated patients.
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Date Issued: 2016
Identifier: CFH2000031, ucf:45572
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFH2000031

Title: PEPSIN AND SALIVARY AMYLASE: BIOMARKERS OF MICROASPIRATION IN ORAL AND TRACHEAL SECRETIONS OF INTUBATED PATIENTS.
Creator: Middleton, Aurea, Sole, Mary Lou, University of Central Florida
Abstract / Description: Introduction: The presence of an endotracheal tube (ETT) increases the risk for microaspiration of secretions around the ETT. Biomarkers of pepsin and salivary amylase may be used to identify microaspiration in intubated patients because of their naturally occurring presence in the stomach or oral cavity and non-occurrence in the respiratory tract. Microaspiration may be difficult to detect until pulmonary complications, such as lung injury or infection, occur. This study assessed the...
Show moreIntroduction: The presence of an endotracheal tube (ETT) increases the risk for microaspiration of secretions around the ETT. Biomarkers of pepsin and salivary amylase may be used to identify microaspiration in intubated patients because of their naturally occurring presence in the stomach or oral cavity and non-occurrence in the respiratory tract. Microaspiration may be difficult to detect until pulmonary complications, such as lung injury or infection, occur. This study assessed the presence of pepsin and salivary amylase in oral and tracheal secretions of ventilated adults. Method(s): This is a secondary analysis of data collected from 11 critically ill, adult patients on mechanical ventilation (MV) enrolled in a study to identify cues for ETT suctioning. Two paired samples of oral and tracheal secretions were suctioned when clinically indicated. Tracheal secretions were suctioned with a closed system, and oral secretions were obtained with an oropharyngeal catheter. Specimens were analyzed for total pepsin, pepsin A, pepsin C, and salivary amylase according to established assays. Results: Of 11 subjects, the majority were men (n=8), on enteral feedings (n=9) via a feeding tube placed in the stomach (n=7), and intubated with a continuous subglottic suction ETT (n=8). Median values: age, 62 years; duration of MV, 5.5 days; ETT cuff pressure 24 cm H2O; head of bed, 30[degrees]. Pepsin was in measured in both oral (30.5 ng/mL; n=8) and tracheal secretions (11.1 ng/mL; n=7); Similar findings were noted for pepsin A (oral 14.7 ng/mL, n=7; sputum 7.4 ng/mL, n=6) and pepsin C (oral 14.7, n=7; tracheal 7.4, n=6). Salivary amylase (mean [micro]mol/min/mL) was present in all oral secretions (359.8) and in the sputum of 6 subjects (1.8). Discussion & Conclusions: The majority of intubated patients on MV had both pepsin and salivary amylase in their sputum, likely due to microaspiration of secretions. This finding suggests greater efforts are needed to reduce patients' risk. Ongoing strategies to prevent gastric reflux are important such as head of bed elevation and monitoring residuals. Presence of salivary amylase within tracheal secretions may indicate a need for more frequent oropharyngeal suctioning as part of routine care of intubated patients. Analysis shows no variations of the presence of pepsin or salivary amylase in relation to feeding tube placement or type of ETT. Generalizability is limited by the small sample size.
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Date Issued: 2012
Identifier: CFH0004281, ucf:44897
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFH0004281

Title: AN EVALUATION OF TRACHEOSTOMY CARE ANXIETY RELIEF THROUGH EDUCATION AND SUPPORT (T-CARES): A PILOT STUDY.
Creator: Crosby, William, Sole, Mary Lou, University of Central Florida
Abstract / Description: Background: Home care of a patient with a tracheostomy after surgery for head and neck cancer requires the caregiver to be proficient with new equipment and required skills. The responsibility of managing an artificial airway, may lead to an increase in caregiver anxiety. Education of caregivers varies; it is often a 1:1 impromptu instruction provided by the patient's nurse and/or respiratory therapist. The purpose of this study was to evaluate the effect of the T-CARES course on caregiver...
Show moreBackground: Home care of a patient with a tracheostomy after surgery for head and neck cancer requires the caregiver to be proficient with new equipment and required skills. The responsibility of managing an artificial airway, may lead to an increase in caregiver anxiety. Education of caregivers varies; it is often a 1:1 impromptu instruction provided by the patient's nurse and/or respiratory therapist. The purpose of this study was to evaluate the effect of the T-CARES course on caregiver anxiety and tracheostomy suctioning competency. Method: A quasi-experimental non-randomized control group design was used. The independent variable was method of instruction (T-CARES versus standard). Dependent variables were caregiver anxiety and tracheostomy suction competence. Caregivers (n=12) self selected into groups based on availability to attend T-CARES course. The control group was to receive the unit-based standard of education. The experimental group participated in the T-CARES course. Only one person chose to be in the control group; therefore, data were analyzed for the experimental group only (N=11). The T-CARES course, created by the researcher, was standardized and instructor-led; it incorporated media and simulated practice. Caregiver anxiety for both groups was obtained before (State/Trait Anxiety) and after (State Anxiety) tracheostomy care instruction was provided. Tracheostomy suctioning competence was assessed using a standardized checklist for participants in the T-CARES study group only. Demographic data were summarized with frequencies and descriptive statistics. Given the small sample size, non-parametric statistics were used for data analysis. Results: Data were analyzed from the experimental group only (n=11). The majority of caregivers were women (n=7), white/caucasian (n=10), married (n=8), employed full time (n=7), and were high school graduates or higher (n=10). The mean age of participants was 50.8 years. Seven of the participants reported previous caregiver experience. Mean score of caregiver trait anxiety was 36.8. Mean caregiver state anxiety score was 50.5 before, and 34.3 after the T-CARES intervention. A Related-Samples Wilcoxon Signed Rank Test was performed on the pre and post T-CARES intervention state anxiety scores. The T-CARES intervention significantly reduced anxiety (p=.008). Tracheostomy suctioning competency for 9 of the participants was evaluated upon completion of T-CARES. Mean score was10.8 skills performed correctly out of a possible 14. Caregivers' responses regarding their biggest fear/concern about tracheostomy care included "not doing it right," "trach coming out or being blocked," "hurting the patient," and "not being able to help in an emergency." Participants' suggestions for future improvements were creation of a Spanish language course and the addition of supplementary training to include CPR, First Aid, and the management of feeding tubes. Discussion: Research supported the hypothesis that the T-CARES course would be successful in reducing state anxiety. The T-CARES course also had a positive impact on tracheostomy suctioning competency, though without a control group it is difficult to quantify the effect. The continued development and dissemination of T-CARES to all tracheostomy patients and their caregivers may ease their transition home. The views expressed are those of the author and do not reflect the official policy or position of the US Air Force, Department of Defense or the US Government.
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Date Issued: 2012
Identifier: CFH0004138, ucf:44824
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFH0004138

Title: NON-INVASIVE POSITIVE PRESSURE VENTILATION (NPPV): ITS USES, COMPLICATIONS, & IMPLICATIONS WITHIN NURSING PRACTICE IN ACUTE CARE SETTINGS.
Creator: Marano, Alexis, Sole, Mary, University of Central Florida
Abstract / Description: The use of noninvasive positive pressure ventilation (NPPV) in acute care settings has drastically increased within the past 20 years. Research has indicated that NPPV is equally as effective as traditional mechanical ventilation(MV) in treating acute exacerbations of chronic pulmonary obstructive disease (COPD) and cardiogenic pulmonary edema. Furthermore, the risk of complication from NPPV is much lower than MV, in terms of ventilator-associated pneumonia and sepsis. It is imperative for...
Show moreThe use of noninvasive positive pressure ventilation (NPPV) in acute care settings has drastically increased within the past 20 years. Research has indicated that NPPV is equally as effective as traditional mechanical ventilation(MV) in treating acute exacerbations of chronic pulmonary obstructive disease (COPD) and cardiogenic pulmonary edema. Furthermore, the risk of complication from NPPV is much lower than MV, in terms of ventilator-associated pneumonia and sepsis. It is imperative for the nurse to understand the various indications, interfaces, and potential complications associated with NPPV use. In addition to treating acute exacerbations of COPD and cardiogenic pulmonary edema, NPPV has been used for prevention of reintubation, palliative care, and status asthmaticus. Furthermore, NPPV could be delivered through various interfaces, such as nasal, facial, and helmet. Each of these interfaces could eventually cause complications for the patient, such as skin ulceration and sepsis. However, there is limited amount of research available discussing the role of the nurse in caring for the patient with NPPV. There are no standardized guidelines established to assist the nurse in this care, in terms of interface selection, prevention of complications, and staffing patterns. Several recommendations are presented at the end of this thesis to guide future nursing research, education, and clinical practice, such as exploring the role of oral care and education for NPPV patients.
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Date Issued: 2012
Identifier: CFH0004276, ucf:44937
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFH0004276

Title: THE IMPACT OF A NURSE-DRIVEN EVIDENCE-BASED DISCHARGE PLANNING PROTOCOL ON ORGANIZATIONAL EFFICIENCY AND PATIENT SATISFACTION IN PATIENTS WITH CARDIAC IMPLANTS.
Creator: King, Tracey, Sole, Mary Lou, University of Central Florida
Abstract / Description: Purpose: Healthcare organizations are mandated to improve quality and safety for patients while stressed with shorter lengths of stay, communication lapses between disciplines, and patient throughput issues that impede timely delivery of patient care. Nurses play a prominent role in the safe transition of patients from admission to discharge. Although nurses participate in discharge planning, limited research has addressed the role and outcomes of the registered nurse as a leader in the...
Show morePurpose: Healthcare organizations are mandated to improve quality and safety for patients while stressed with shorter lengths of stay, communication lapses between disciplines, and patient throughput issues that impede timely delivery of patient care. Nurses play a prominent role in the safe transition of patients from admission to discharge. Although nurses participate in discharge planning, limited research has addressed the role and outcomes of the registered nurse as a leader in the process. The aim of this study was determine if implementation of a nurse-driven discharge planning protocol for patients undergoing cardiac implant would result in improved organizational efficiencies, higher medication reconciliation rates, and higher patient satisfaction scores. Methods: A two-group posttest experimental design was used to conduct the study. Informed consent was obtained from 53 individuals scheduled for a cardiac implant procedure. Subjects were randomly assigned to either a nurse-driven discharge planning intervention group or a control group. Post procedure, 46 subjects met inclusion criteria with half (n=23) assigned to each group. All subjects received traditional discharge planning services. The morning after the cardiac implant procedure, a specially trained registered nurse assessed subjects in the intervention for discharge readiness. Subjects in the intervention groups were then discharged under protocol orders by the intervention nurse after targeted physical assessment, review of the post procedure chest radiograph, and examination of the cardiac implant device function. The intervention nurse also provided patient education, discharge instructions, and conducted medication reconciliation. The day after discharge the principal investigator conducted a scripted follow-up phone call to answer questions and monitor for post procedure complications. A Hospital Discharge Survey was administered during the subject's follow-up appointment. Results: The majority of subjects were men, Caucasian, insured, and educated at the high school level or higher. Their average age was 73.5+ 9.8 years. No significant differences between groups were noted for gender, type of insurance, education, or type of cardiac implant (chi-square); or age (t-test). A Mann-Whitney U test (one-tailed) found no significant difference in variable cost per case (p=.437) and actual charges (p=.403) between the intervention and control groups. Significant differences were found between groups for discharge satisfaction (p=.05) and the discharge perception of overall health (p=.02), with those in the intervention group reporting higher scores. Chi square analysis found no significant difference in 30-day readmission rates (p=.520). Using an independent samples t-test, those in the intervention group were discharged earlier (p=.000), had a lower length of stay (p=.005), and had higher rates of reconciled medications (p=.000). The odds of having all medications reconciled were significantly higher in the intervention group (odds ratio, 50.27; 95% CI, 5.62-450.2; p=.000). Discussion/Implications: This is the first study to evaluate the role of the nurse as a clinical leader in patient throughput, discharge planning, and patient safety initiatives. A nurse driven discharge planning protocol resulted in earlier discharge times which can have a dramatic impact on patient throughput. The nurse driven protocol significantly reduced the likelihood of unreconciled medications at discharge and significantly increased patient satisfaction. Follow-up research is needed to determine if a registered nurse can impact organizational efficiency and discharge safety in other patient populations.
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Date Issued: 2008
Identifier: CFE0002188, ucf:47915
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0002188

Title: A COMPARISON OF COMPUTER AND TRADITIONAL FACE-TO-FACE CLASSROOM ORIENTATION FOR BEGINNING CRITICAL CARE NURSES.
Creator: Anzalone, Patricia, Sole, Mary Lou, University of Central Florida
Abstract / Description: Purpose: Education of the novice critical care nurse has traditionally been conducted by critical care educators in face-to-face classes in an orientation or internship. A shortage of qualified educators and growth in electronic modes of course delivery has led organizations to explore electronic learning (e-learning) to provide orientation to critical care nursing concepts. Equivalence of e-learning versus traditional critical care orientation has not been studied. The primary aim of this...
Show morePurpose: Education of the novice critical care nurse has traditionally been conducted by critical care educators in face-to-face classes in an orientation or internship. A shortage of qualified educators and growth in electronic modes of course delivery has led organizations to explore electronic learning (e-learning) to provide orientation to critical care nursing concepts. Equivalence of e-learning versus traditional critical care orientation has not been studied. The primary aim of this study was to examine the equivalency of knowledge attainment in the cardiovascular module of the Essentials of Critical Care Orientation (ECCO) e-learning program to traditional face-to-face critical care orientation classes covering the same content. Additional aims were to determine if learning style is associated with a preference for type of learning method, and to determine any difference in learning satisfaction between the two modalities. Methods: The study was conducted using a two-group pretest-posttest experimental design. Forty-one practicing volunteer nurses with no current critical care experience living in southwest Florida were randomly assigned to either the ECCO (n=19) or face-to-face (n=22) group. Those in the face-to-face group attended 20 hours of classroom instruction taught by an expert educator. Those in the ECCO group completed the lessons on line and had an optional 2 hour face-to-face discussion component. Pre-test measures included the Basic Knowledge Assessment Test (BKAT-7), modified ECCO Cardiovascular (CV) Examination, and Kolb Learning Style Inventory (LSI). Post-tests included the BKAT-7, modified CV Examination, and Affective Measures Survey. Results: The majority of subjects were female, married, and educated at the associate degree level. Their mean age was 39.5 + 12 years, and they averaged 9.9 + 11.7 years of nursing experience. The diverging learning style was assessed in 37% of subjects. Classroom instruction was preferred by 61% of participants. No statistical differences were noted between groups on any demographic variables or baseline knowledge. Learning outcomes were compared by repeated measures analysis of variance. Mean scores of subjects in both groups increased statistically on both the BKAT-7 and modified CV Examination (p=<.01); however, no significant differences (p> .05) were found between groups. Preference for online versus classroom instruction was not associated with learning style (X2 = 3.39, p = .34). Satisfaction with learning modality was significantly greater for those in the classroom group (t=4.25, p=.000). Discussion/Implications: This is the first study to evaluate the ECCO orientation program and contributes to the growing body of knowledge exploring e-learning versus traditional education. The results of this study provide evidence that the ECCO critical care education produces learning outcomes at least equivalent to traditional classroom instruction, regardless of the learning style of the student. As participant satisfaction was more favorable toward the classroom learning modality, consideration should be given to providing blended learning if using computer-based orientation programs. Replication of this study with a variety of instructors in varied geographic locations, expanded populations, larger samples, and different subject matter is recommended.
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Date Issued: 2008
Identifier: CFE0002192, ucf:47888
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0002192

Title: THE EFFECT OF COMBAT EXERCISES ON CARDIOVASCULAR RESPONSE: AN EXPLORATORY STUDY.
Creator: Gantt, MeLisa, Sole, Mary Lou, University of Central Florida
Abstract / Description: PURPOSE: Hypertension (HTN) affects one in every three adults in the United States. Often associated with the older population, this silent killer has emerged in an unsuspecting group, young military soldiers. With the rapid succession of multiple deployments, long intervals between blood pressure (BP) assessments, and the absence of cardiovascular (CV) measures during the pre and post deployment health screenings; soldiers may be at higher risk for HTN than their civilian counterparts of the...
Show morePURPOSE: Hypertension (HTN) affects one in every three adults in the United States. Often associated with the older population, this silent killer has emerged in an unsuspecting group, young military soldiers. With the rapid succession of multiple deployments, long intervals between blood pressure (BP) assessments, and the absence of cardiovascular (CV) measures during the pre and post deployment health screenings; soldiers may be at higher risk for HTN than their civilian counterparts of the same age. The purpose of this study was to explore real-time continuous CV measures of soldiers before, during, and after exposure to a simulated combat stressor as well as to assess which personal characteristics played a significant role. METHODS: Applying the Allostasis/Allostatic Load theoretical framework, a repeated measure quasi-experimental design was used to compare the CV measures of two groups: one exposed to a physical combat stressor (experimental) and the other exposed to a psychological combat stressor (control). A convenience sample of 60 college Army Reserve Officer Training Corps cadets were fitted with Tiba Medical Ambulo 2400 ambulatory BP monitors for 48 continuous hours. Several CV indices were analyzed using one-way Analysis of Variance (ANOVA), paired t-test, and independent sample t-test. Four instruments (Participant Information Sheet, State-Trait Anxiety Inventory, Paintball Perceived Stress Questionnaire, and Army Physical Fitness Test) were used to assess which characteristics played the most significant role in the CV response. RESULTS: Demographic characteristics between the two 30-cadet groups were not statistically different, with the exception of deployment history (experimental = 4, control= 0). Hours after the stress exposure, subjects in the experimental group had a higher mean awake systolic blood pressure (SBP) when compared to the control group (113.76 mm Hg vs 102.98 mm Hg, p= 009). When assessing pre and post stressor morning BP surge and evening BP decline, the control group showed the biggest change. Significant bivariate correlations (p < .05) found that: Females consistently had higher pulse rates (PR) throughout each of the phases. Age positively correlated with elevated BP during the stressor, and increased morning BP surge post stressor. African Americans had higher sleep BPs pre stressor, and decreased SBP recovery post stressor; Hispanics had higher PRs during and after the stressor. Waist circumference positively correlated with elevated BP morning surge pre stressor but, body mass index (BMI) positively correlated with elevated BP morning surge post stressor as well as elevated BP during the stressor. Family history of HTN played no significant role; however, deployment history correlated with mean awake SBP post stressor. Trait anxiety scores negatively correlated with SBP recovery while state anxiety scores positively correlated with post stressor awake mean arterial pressure and evening SPB decline. Perceived stress during the stressor negatively correlated with post stressor SBP morning surge with females reporting higher anxiety and stress. Finally, Army Physical Fitness (APFT) total scores as well as APFT run scores negatively correlated with pre and post stressor sleep PRs. DISCUSSION/IMPLICATIONS: Age, female gender, African American descent, Hispanic ethnicity, waist circumference, BMI, previous deployment history, level of fitness and the psychological stress state during and after a stressor played significant roles in soldiersÃƒÂƒÃ‚Â‚ÃƒÂ‚Ã‚Â' CV response. SBP was the most dynamic and informative of the CV indices and a psychological stressor was comparable to a physical stressor when observing the residual effect of stress. If a combat exercise was enough of a stressor to produce residual CV effects that lasted well into following morning, the residual effect of a lengthy strenuous deployment may be alarming. This study not only provided a snapshot of the CV health of incoming young soldiers, but also provided evidence to support policy change regarding the implementation of regular CV health assessments before and after deployment.
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Date Issued: 2010
Identifier: CFE0003390, ucf:48458
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0003390

Title: CLOPIDOGREL PROVISION FOR INDIGENT PATIENTS WITH ST-ELEVATION MYOCARDIAL INFARCTION.
Creator: Price, Sita, Sole, Mary Lou, University of Central Florida
Abstract / Description: The Joint Commission in a joint effort with the Centers of Medicare and Medicaid Services (CMS) has established certain "core measures" by which hospital performance is measured. One of these is the measure for patients with ST-elevation myocardial infarction (STEMI) recommending percutaneous coronary intervention within 90 minutes of presentation to the Emergency Department in institutions that are able to provide this service. This recommendation does not take into account the long-term use...
Show moreThe Joint Commission in a joint effort with the Centers of Medicare and Medicaid Services (CMS) has established certain "core measures" by which hospital performance is measured. One of these is the measure for patients with ST-elevation myocardial infarction (STEMI) recommending percutaneous coronary intervention within 90 minutes of presentation to the Emergency Department in institutions that are able to provide this service. This recommendation does not take into account the long-term use of clopidogrel that is recommended by the American College of Cardiology and American Heart Association for patients that are treated with coronary stents. The purpose of this study was to evaluate outcomes of providing a short course of clopidogrel versus a prescription alone for clopidogrel to uninsured patients experiencing STEMI who were treated with a bare metal stent. After conducting a cost-benefit analysis, a policy was approved that provided uninsured STEMI patients with clopidogrel at discharge rather than a prescription. A social worker evaluated patients to determine if they met criteria and arranged for medication delivery to the patient's bedside. A retrospective chart review for all patients who presented to the Emergency Department during two different time frames (before and after policy implementation) was conducted to evaluate if providing clopidogrel decreased readmissions. Data were collected on over a 15-month period of time before and after the clopidogrel policy implementation to allow for evaluation of 90-day readmissions with repeat STEMI. Data were analyzed using chi-square cross tabulation and T-test for independent samples. A total of 201 charts were reviewed: 100 from the pre-intervention group and 101 from the post-intervention group. Demographic characteristics of age, gender and insurance status were not statistically different between groups. The mean age for the control group was 59.1 (+ 13.8) years and 58.9 (+ 13.6) years for the intervention group. Twenty percent of the patients were uninsured. Five uninsured patients were readmitted with STEMI prior to the intervention compared to two patients in the intervention group (p = .191). The admissions for the pre-intervention patients occurred in the first 30 days after discharge compared to 31-60 days in the post-intervention group. All of the patients who were readmitted were assessed to be noncompliant with treatment. Additionally, a transition to increased use of bare metal stents in STEMI patients from 23.1% pre-intervention to 67.4% post-intervention was noted (p < .001). Although no differences were found in readmission rates, fewer readmissions for STEMI were noted after the intervention. The small number of patients who were readmitted with STEMI likely accounted for this finding, and additional monitoring of readmission rates is warranted. Despite provision of the clopidogrel, adherence remains an issue and needs to be addressed. During the intervention, physicians were encouraged to consider the financial and social resources of individual STEMI patients presenting to the Emergency Department to help identify patients that would be less likely to adhere to antiplatelet therapy. In those believed to be at high risk for non-adherence, primarily due to inability to purchase the relatively expensive medication clopidogrel, many physicians chose to insert bare metal stents rather than drug-eluting stents to take advantage of the shorter course of clopidogrel required post procedure. Provision of a 30-day course of clopidogrel and aspirin was a major part of this effort to decrease recurrent myocardial infarction in this at-risk population. A few patients eligible for the clopidogrel were not provided the medication if they were admitted to a nursing unit where staff members were not familiar with the policy; revisions to the policy to ensure medication is provided to all eligible patients will be made. Providing clopidogrel to patients who experience STEMI may improve adherence and thereby decrease readmissions as a result of repeat STEMI due to subacute thrombus formation. Patients who experience STEMI continue to be vulnerable after STEMI. Programs that provide medication to patients should be expanded within this facility and to other hospital systems to encompass all patients who are treated for STEMI. Multi-disciplinary collaboration is necessary in developing and implementing a program that will address care for this.
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Date Issued: 2011
Identifier: CFE0003940, ucf:48685
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0003940

Title: EFFECTS OF AN EVIDENCE-BASED INTERVENTION ON STRESS AND COPING OF FAMILIES OF CRITICALLY ILL TRAUMA PATIENTS.
Creator: Knapp, Sandra, Sole, Mary Lou, University of Central Florida
Abstract / Description: Problem/Purpose: Critical care nurses are frequently exposed to the stress experienced by their patients' families, yet they often do not have the knowledge or skills to help family members cope with the stress of critical illness. While needs and stressors of families of the critically ill have been researched extensively, no prior studies have been conducted to determine the effects of an evidence-based nursing intervention for reducing family members' stress and improving their coping...
Show moreProblem/Purpose: Critical care nurses are frequently exposed to the stress experienced by their patients' families, yet they often do not have the knowledge or skills to help family members cope with the stress of critical illness. While needs and stressors of families of the critically ill have been researched extensively, no prior studies have been conducted to determine the effects of an evidence-based nursing intervention for reducing family members' stress and improving their coping skills. The purpose of this study was to determine if an evidence-based nursing intervention designed to address the needs of family members would reduce stress and improve coping skills in family members of critically ill trauma patients. Additionally, the study assessed the family members' perceptions of how well their needs were met while their loved one was hospitalized in the surgical intensive care unit (SICU). Methods: Using a quasi-experimental, nonequivalent control group design, an evidence-based intervention for critical care nurses was implemented to test its effect on stress and coping of family members of critically ill trauma patients. The study setting was the SICU at a tertiary university hospital in north central Florida. Subjects were family members of critically ill trauma patients who had been hospitalized in the SICU for at least 48 hours. Participants in the control group were given a packet containing instruments that measured 1) anxiety as an indicator of stress (Spielberger's State-Trait Anxiety Inventory ); 2) coping (Lazarus and Folkman's Ways of Coping Questionnaire ); and 3) assessment of family members' perception of having their needs met while their family member was in the SICU (Family Care Survey ). An evidence-based family bundle was implemented over an eight-week period and included an educational program for the nurses. After eight weeks, participants in the experimental group were given the same instruments previously administered to the control group. Anxiety levels, coping skills, and family members' perception of having needs met were compared between the two groups to determine the effectiveness of the evidence-based intervention. Results: A total of 84 family members participated in the study (control = 39; experimental = 45). The majority were women (n=60), spouse or parent of the patient (n=47), and Caucasian (n=70). Mean ages were 45.9 years for the control group and 47.4 years for the experimental group. No differences were noted in the demographic characteristics between the control and experimental groups. Using an independent samples t-test, no significant differences (p > .05) were noted between groups for either state or trait anxiety, although the mean anxiety score was lower in the experimental group. Significant differences between groups were noted on two of the eight coping subscales: Distancing and Accepting Responsibility. Improved coping, although not statistically significant, was noted on four additional subscales: Confrontive Coping, Self-Controlling, Planful Problem-Solving, and Positive Reappraisal. Overall coping scores also improved, but not statistically, for the total Ways of Coping Scale (both 50 and 66 item totals). Although not statistically significant, participants in the experimental group rated four out of eight items higher on the FCS, indicating an increased perception that more of their needs were met, greater overall satisfaction with the care that family members received, increased nurses' consideration of family members' needs and the inclusion of those needs in planning nursing care, and greater encouragement for family members to participate in care. Although findings were not statistically significant, the trend implies increased satisfaction with family care in areas involving family care and family member needs, including needs in planning care and encouragement to participate in care. In areas regarding information and communication, there was overall less satisfaction in both groups. Conclusions: This study provides data that can be used as a guide in developing programs that help families function and adapt to the extremely stressful experience of having a loved one who is critically ill. The information can be used to develop future research on larger scales with a longer and more extensive plan for implementation of the intervention to assist in a unit culture change. Nurses can use the results to facilitate practice changes in caring for families of critically ill patients. Modifying the interventions to focus on an interdisciplinary approach to meet families' needs, reduce stress, and improve coping also warrants further development and testing. Funding acknowledgement: Florida Nurses Foundation and the American Association of Critical Care Nurses. College of Nursing, University of Central Florida
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Date Issued: 2009
Identifier: CFE0002774, ucf:48134
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0002774

Title: THE IMPACT OF AN INTERDEPENDENT CONFERENCING ACTIVITY IN AN ONLINE RN-BSN PRACTICUM CLINICAL CONFERENCE ON PSYCHOLOGICAL SENSE OF COMMUNITY.
Creator: Lange, Barbara, Sole, Mary Lou, University of Central Florida
Abstract / Description: RN-BSN students enrolled in a clinical course often have limited or no interaction with other students within the course due to geographic distance and individual preceptor assignments. Learning is often restricted to a student and his/her preceptor and instructor. Geographic and physical distance factors inhibit a studentÃÂÃÂÃÂÃÂ's perception of connectedness and learning. Interdependent interaction between peers, the instructor, and the professional community may increase student...
Show moreRN-BSN students enrolled in a clinical course often have limited or no interaction with other students within the course due to geographic distance and individual preceptor assignments. Learning is often restricted to a student and his/her preceptor and instructor. Geographic and physical distance factors inhibit a studentÃƒÂƒÃ‚Â‚ÃƒÂ‚Ã‚Â's perception of connectedness and learning. Interdependent interaction between peers, the instructor, and the professional community may increase student achievements and enhance a sense of connectedness. The purpose of this study was to assess the effects of an Interdependent Conferencing Activity (ICA) in an online clinical conference on RN-BSN students' Psychological Sense of Community (PSOC). Students' perception of learning and connectedness are the secondary outcome measurements for PSOC. The ICA was developed to promote interdependence and interaction to enhance PSOC. The research supports the hypothesis that implementation of an ICA will increase PSOC in RN-BSN students in the intervention group when compared to the control and comparison group in an online clinical conference. An experimental, pre-test, post-test research study was conducted to test the hypothesis that implementation of an ICA will increase PSOC in RN-BSN students in the intervention group when compared to the control and comparison group in an online clinical conference. RN-BSN students enrolled in their clinical practicum course (two sections over two semesters) were recruited to participate at the beginning of the course. Each of the sections had a web component. Those who consented to participate were randomly assigned to one of three groups: control, comparison, or intervention. The control group responded to focused questions; the comparison group answered questions related to the application of knowledge gained within their practicum experiences; and the intervention group responded to inquiry about the same theoretical concept from the perspective of their total professional experience, citing examples to support or change evidence-based practice. The Classroom Community Scale (CCS) developed by Rovai (2002c) for use in online course assessment was administered at the beginning and end of the course to measure PSOC and its subscales of learning and connectedness. A total of 67 students participated (control n = 20, comparison n = 22, intervention n = 25). The majority of subjects were female (91%) and Caucasian (83.6%). Their average age was 31.4 years and they had an average of 6.4 years of experience as an RN. With the exceptions of years of experience, demographic characteristics were similar for each group. There was a significant difference for PSOC among the groups (RMANOVA; p = <.001). Post hoc analyses indicated a significant difference in the total PSOC and the subscales of Connectedness and Learning between the experimental group and both the control and comparison groups. Implementation of an ICA enhanced PSOC in an online RN-BSN online conference. The development and implementation of the intervention supported the research hypothesis, the 21st Century educational factors, and the use of experiential learning in the profession of nursing. This research addressed two critical gaps in literature: a paucity of research available on clinical conferencing in nursing, and clinical conferencing within the RN-BSN population. The ICA is an action that could easily be implemented in online conferencing.
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Date Issued: 2010
Identifier: CFE0003155, ucf:48594
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0003155

Title: THE EFFECTIVENESS OF INTERVENTIONS AND BUNDLES FOR CENTRAL LINE-ASSOCIATED BLOODSTREAM INFECTIONS IN THE NEONATAL INTENSIVE CARE UNIT.
Creator: Alhamwi, Mohamad, Ramirez, Bernardo, Sole, Mary Lou, University of Central Florida
Abstract / Description: Introduction: Central Line-Associated Bloodstream Infections (CLABSIs) are a major cause of increased mortality, morbidity and healthcare costs in neonatal intensive care units (NICUs) patients. Despite CDC's efforts to reduce infection rates, patients often suffer consequences. The objective of this study is to perform a systematic review of strategies utilized in the neonatal population and evaluate them with the current CDC's guidelines to assess the effectiveness of bundles in preventing...
Show moreIntroduction: Central Line-Associated Bloodstream Infections (CLABSIs) are a major cause of increased mortality, morbidity and healthcare costs in neonatal intensive care units (NICUs) patients. Despite CDC's efforts to reduce infection rates, patients often suffer consequences. The objective of this study is to perform a systematic review of strategies utilized in the neonatal population and evaluate them with the current CDC's guidelines to assess the effectiveness of bundles in preventing CLABSI in NICUs. Methods: A systematic literature search was conducted using CINAHL Plus with Text, Cochrane Database of Systematic Reviews and MEDLINE from January 2008 up to 2018. There were multiple search terms used and these included "neonate OR newborn OR infant", "CLABSI OR central line-associated bloodstream infection", "intervention OR prevention" and "bundle". The search solely focused on the outcome of infant patients. Therefore studies were excluded for the following criteria: being non-peer reviewed, being published before 2008, and being a case in which CLABSI was assessed in patients outside the NICU. See Table 4 and 5 for further information. Results: Eight articles were eligible for inclusion all of which CDC's guidelines were implemented in their strategy of intervention. The systematic review showed that adherence to care bundles decreases infection rates drastically. All eight articles reported a significant decrease in CLABSI rates following the implementation of the bundle set by CDC with two studies achieving a CLABSI rate of zero. Author's Conclusion: Implementation of care bundles showed a success in reducing CLABSI rates in the NICUs; however none of the studies endorsed a specific bundle application utilized to achieve its intended goal. Some practices adopted CDC's guidelines more than others and those showed a greater decrease in infection rate. In addition, it is evident that nurses deliver the best care when preventing an infection. Further research is needed to assess the effectiveness of a specific bundle element.
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Date Issued: 2018
Identifier: CFH2000407, ucf:45736
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFH2000407

Title: PRONE POSITIONING IN ACUTE RESPIRATORY DISTRESS SYNDROME PATIENTS.
Creator: Thornton, Sarah Rose H, Sole, Mary Lou, Bourgault, Annette, University of Central Florida
Abstract / Description: Introduction: Acute respiratory distress syndrome (ARDS), seen in critically ill patients, is a disease process that affects the lungs and directly impacts a patient's oxygenation. Despite treatment, patients often die of ARDS secondary to systemic complications. Prone positioning has been introduced as a treatment to improve the outcomes of ARDS patients. This thesis summarized and critiqued recent literature on the outcomes of prone positioning in ARDS patients. Methodology: An initial...
Show moreIntroduction: Acute respiratory distress syndrome (ARDS), seen in critically ill patients, is a disease process that affects the lungs and directly impacts a patient's oxygenation. Despite treatment, patients often die of ARDS secondary to systemic complications. Prone positioning has been introduced as a treatment to improve the outcomes of ARDS patients. This thesis summarized and critiqued recent literature on the outcomes of prone positioning in ARDS patients. Methodology: An initial literature search was conducted using CINAHL Plus with Text, Medline, Cochrane Database of Systematic Reviews, and US National Library of Medicine National Institutes of Health. Multiple search terms were used. Inclusion criteria consisted of peer reviewed research articles, academic journal articles, and evidence-based research or practices published within the last ten years. All studies included adult subjects and were published in the English language. Studies that did not address patient outcomes such as mortality, length of stay, or hemodynamic oxygenation were excluded from the review. Results: The review of literature contains one meta-analysis and two studies. Data indicated that prone positioning was statistically significant in reducing mortality when performed in sessions of 12 hours or longer (p=0.05). Hemodynamic oxygenation improved significantly after at least 48 hours of implementing prone positioning. There was no trend in the length of stay or duration in mechanical ventilation whether supine or prone positioning was used. Complications such as endotracheal tube dislodgement, incidence of ventilator-associated pneumonia, and pressure ulcers were reported in both supine and prone position with an increased risk of pressure ulcers and endotracheal tube obstruction in the prone position groups. Conclusions: Findings support a benefit in patient outcomes in patients placed in prone position with ARDS. Mortality was reduced when prone sessions lasted longer than 12 hours possibly due to the improvement in patient oxygenation 48 hours after initiation of prone positioning intervention. Further research is needed to solidify these findings and establish guidelines and optimal procedural methods to maximize patient outcomes and lower the incidence of patient complications.
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Date Issued: 2018
Identifier: CFH2000337, ucf:45861
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFH2000337

Title: PEPSIN AND AMYLASE IN ORAL AND TRACHEAL SECRETIONS OF PATIENTS WITH STANDARD VERSUS CONTINUOUS SUBGLOTTIC SUCTIONING ENDOTRACHEAL TUBES.
Creator: Allen, Katherine, Sole, PhD, Mary Lou, University of Central Florida
Abstract / Description: The aspiration of oral and gastric substances is a well-known risk for ventilator associated pneumonia (VAP) in the intubated, mechanically ventilated (MV), patient of the intensive care unit (ICU) population. The gastric biomarker pepsin and the oral biomarker salivary amylase have been identified as evidence of aspiration prior to the manifestation of acute pulmonary illness. In an effort to decrease the risk for aspiration, several evidence based nursing practices are in place. Actions...
Show moreThe aspiration of oral and gastric substances is a well-known risk for ventilator associated pneumonia (VAP) in the intubated, mechanically ventilated (MV), patient of the intensive care unit (ICU) population. The gastric biomarker pepsin and the oral biomarker salivary amylase have been identified as evidence of aspiration prior to the manifestation of acute pulmonary illness. In an effort to decrease the risk for aspiration, several evidence based nursing practices are in place. Actions include 30 degree head of the bed positioning, oral care, suctioning, and circuit change interval protocols, as well as the administration of medication with the objective of reducing acid reflux. Additional recommendations concern the type of endotracheal tube (ETT) used to ventilate the intubated patient. The continuous subglottic suctioning endotracheal tube (CSS-ETT) features an additional port which continually suctions secretions that accumulate above the inflated endotracheal cuff. Patients with standard endotracheal tubes (S-ETT) receive manual, as needed suctioning of accumulated secretions in the mouth and the oropharynx per agency protocol. Research of the critical care population has demonstrated a decreased instance of VAP using CSS-ETT as compared to S-ETT utilization. This study sought to compare the incidence of the biomarkers pepsin and salivary amylase in the suctioned oral and tracheal secretions of patients with S-ETT compared to patients with CSS-ETT. Part of the protocol of a descriptive, comparative study of the clinical indicators for suctioning established the collection of the paired suctioned oral and tracheal aspirates. Those collected aspirates were analyzed for a pilot study of pepsin and amylase analysis. This study compares the incidence of aspirates in oral and tracheal secretions by endotracheal tube type. Tracheal aspirates were obtained with a closed tracheal suction device while oral secretions were obtained with a suction catheter designed to reach the oropharynx. Biomarkers assayed were the gastric marker pepsin and the oropharyngeal marker salivary amylase. Assays of pepsin and salivary amylase were performed using standard procedures in a specialty diagnostic laboratory. Specimens were obtained from 11 subjects: 8 male and 3 female. The majority were Caucasian (n=9), had a CSS-ETT (n=8), were on mechanical ventilation in the synchronized intermittent mandatory ventilation mode, and on tube feedings (n=9) located in the stomach (n=7). The mean age was 56 years. Feeding tubes were placed in 9 patients, and the majority of the tubes were Dobbhoff. Pepsin was found in the oral secretions of 62.5% (n = 5) of the CSS-ETT subjects, while 50.0% (n = 4) had pepsin in the tracheal aspirate. Pepsin was found in the oral secretions of 66.7% (n = 2) of the S-ETT subjects, and 66.7% (n = 2) had pepsin in their tracheal aspirate. All subjects of both groups (n = 11) had oral salivary amylase detected. Salivary amylase was detected in the tracheal aspirate of 100% (n = 3) of the S-ETT subjects versus 62.5% (n = 5) in CSS-ETT group. Based on the results of this study, there was a reduction in the number of subjects who had oral compared to tracheal aspirate pepsin in the CSS-ETT group (n = 5 oral versus n = 4 tracheal) tube type. The S-ETT group had equal number of subjects with oral (n = 2) and tracheal pepsin detected (n = 2). However, the results when comparing the S-ETT and the CSS-ETT groups were not statistically significant (p = 0.898 pepsin oral and 0.621 tracheal pepsin). There may be clinical significance. It appears that the CSS-ETT was beneficial in that group; two fewer subjects had pepsin in their tracheal aspirate (n = 5 oral versus n = 4 tracheal aspirate pepsin). The intention of this study was that it would assist in demonstrating beneficial aspects of the selection of the CSS-ETT. It is considered that further investigation with a larger population group could add statistical significance.
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Date Issued: 2012
Identifier: CFH0004284, ucf:44946
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFH0004284

Title: Development and Evaluation of an Instrument to Measure Mother-Infant Togetherness After Childbirth.
Creator: Lawrence, Carol, Norris, Anne, Byers, Jacqueline, Sole, Mary, Leon, Ana, University of Central Florida
Abstract / Description: No existing measure to date captures mother-infant togetherness. A valid measure of togetherness is essential to engage in evidence-based practice, evaluate obstetric delivery models and nursing interventions, and measure the level of togetherness which promotes optimal maternal-infant outcomes. When together and in close proximity, a women and her infant have access to one another to allow for mutual caregiving or caregiving on cue. A new measure entitled the Mother-Infant Togetherness Scale...
Show moreNo existing measure to date captures mother-infant togetherness. A valid measure of togetherness is essential to engage in evidence-based practice, evaluate obstetric delivery models and nursing interventions, and measure the level of togetherness which promotes optimal maternal-infant outcomes. When together and in close proximity, a women and her infant have access to one another to allow for mutual caregiving or caregiving on cue. A new measure entitled the Mother-Infant Togetherness Scale (MITS) was developed based on a review of the literature and conceptual framework of Mother-Newborn Mutual Caregiving. The MITS is a 35-item instrument composed of four subscales that measures the timing, duration, and intensity of togetherness of the mother-infant dyad during entire hospitalization. The purpose of this multiphase study was to obtain support for the validity of the MITS. Phase 1 determined the content validity at the scale (S-CVI), subscale, and item level (I-CVI) with a panel of expert judges. The final sample for the content validation consisted of 7 judges from medicine (n = 2), maternal-child nursing (n = 1), nursing research (n = 3), and social work (n = 1). Judges were instructed to use a 4-point Likert scale to rate the relevance of each item (I-CVI) to the construct of togetherness. The S-CVI was calculated from the mean I-CVI scores. The CVI-S of .88 was just slightly below the desired CVI-S ((>) .90). Of the four subscales, all had adequate CVI ((>) .90) at the subscale level except the delivery affective subscale (CVI = .74) and postpartum affective subscale (CVI = .89). The delivery events and postpartum events subscales had satisfactory CVI scores (CVI (>) .90), 1.00 and .94, respectively. The CVI-I results identified a total of seven items on the affective subscales that did not meet the desired I-CVI ((>) .78). Phase 2 pre-tested the readability and understandability of the MITS among eight postpartum women. During the interviews, the women were asked to complete the MITS and provide opinions about the readability and understandability of the directions and items. The audiotapes were transcribed word for word, reviewed for thematic content, and revisions made to the study instrument accordingly. This same sample of postpartum women participated in the content validation of the delivery affective subscale (items #4a-j) and postpartum affective subscale (items #17a-j). The I-CVI results identified that a total of six items on the affective subscales had a CVI-I of .75, just slightly below the desired I-CVI ((>) .78). Scale items were deleted or revised and the instrument retested until the desirable CVI at the scale and subscale level was achieved. Phase 3 used a descriptive study design to examine women's ability to accurately self-report birth events on the MITS delivery events subscale at 4 weeks postpartum, as compared to observer-collected data obtained at delivery to determine the most valid mode of administration. A purposive sample consisted of 45 women having delivered at a community hospital in southwest Florida. The research team completed the MITS delivery events subscale immediately after delivery. Women were sent the MITS for completion 4 weeks after delivery. McNemar Chi-Squares were (?) were calculated from the self-reported MITS delivery events subscale scores and the observer-collected MITS delivery events subscale scores. No significant difference (p (<) .05) was found supporting self-reported mode of administration for the MITS. Phase 4 is in-progress and evaluates the reliability and validity of the MITS subscale and total scale scores. The interim analysis was performed on a sample of 113 postpartum participants (composed of the final sample of 31 participants from Phase 3 and the first 82 participants from Phase 4) having delivered at three of the four participating hospital study sites. Adequate internal consistency reliability was found at the scale level with Cronbach's alpha (? = .89) and split-half reliability results (? = .79 (-) 81, r = .83 - .88). Of the 35 MITS items, 10 items (28.6%) were found to have item-total correlations less than .30, arguing against treating MITS items as a single total scale measure. Good internal consistency was found at the delivery events subscale level (? = .78). Exploratory factor analysis (EFA) identified a two-factor solution. The two factors were named Taking In and Taking Control and had internal consistency reliability.79 and .65, respectively. Additional work needs to be done to improve the internal consistency of the Taking Control factor. The postpartum events subscale also had low internal consistency (? = .58). This subscale was not factor analyzed because the item response data did not meet the criteria for factor analysis. The items on the postpartum events subscale were assessed to be unique, singular, heterogeneous items that did not correlate well with other items. These results are conceptually logical given the nature of what the items are measuring (occurrence/intensity of specific events in time). The delivery affective subscale had good internal consistency reliability (? = .85) and a two factor solution. The two factors, named Feelings At Delivery and Delivery Concerns, had adequate internal constancy (? = .81 and ? = .80, respectively). The postpartum affective subscale had good internal consistency reliability (? = .92) and a one factor solution. Results for known groups testing based on feeding type and mode of delivery found all group differences were in the predicted direction. Higher scores were found for mother-infant dyads who breastfed than for mother-infant dyads who bottle fed. However, only group differences for the events subscales were substantive and statistically significant (p (<) 001.). Higher scores were found for mother-infant dyads who experiencing a vaginal delivery than for mother-infant dyads who experienced a cesarean delivery. Group differences were substantive and statistically significant (p (<) .01) for three of the four subscale scores. A post hoc power analysis on the means and standard deviations from the interim analysis and the between-groups comparison effect size observed for feeding type (d = .50) found a sample of 45 adequate to have statistical power at the recommended beta of .80 and alpha of .05. The post hoc power analysis on the effect size for mode of delivery (d = .75), found a sample of 156 are needed to obtain statistical power at the recommended beta of .80 and alpha of .05. Therefore, the desired sample size of 200 women for the final analysis is adequate to obtain statistical power. A third known group testing for the variable of central nursery availability could not be performed with the interim analysis data because no participants in the interim analysis sample reported this experience. However, this analysis will be performed with the final data set. This is the first study to operationalize togetherness during the entire hospitalization and to include all dimensions of the construct. The findings from this multi-phase study provide initial support for the reliability and validity of the MITS. Although the results from Phase 4 are interim and therefore tentative, they provide preliminary psychometric evidence for construct validity.
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Date Issued: 2012
Identifier: CFE0004567, ucf:49200
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0004567

Title: Adherence Practices of Caucasian Women With Hypertension Residing in Rural Florida: An Exploratory Study.
Creator: Hopple, Jeanne, Bushy, Angeline, Sole, Mary, Covelli, Maureen, Oetjen, Dawn, University of Central Florida
Abstract / Description: Hypertension, or high blood pressure, is a major risk factor for heart disease and stroke. Elevated blood pressure is often a silent process affecting multiple organ systems. Risk for heart disease is associated with poorly treated or unrecognized hypertension that is more common among women than men. Non-adherence to prescribed treatment regimens has been identified as a major reason for inadequate hypertension management. This exploratory descriptive qualitative study using narrative...
Show moreHypertension, or high blood pressure, is a major risk factor for heart disease and stroke. Elevated blood pressure is often a silent process affecting multiple organ systems. Risk for heart disease is associated with poorly treated or unrecognized hypertension that is more common among women than men. Non-adherence to prescribed treatment regimens has been identified as a major reason for inadequate hypertension management. This exploratory descriptive qualitative study using narrative inquiry investigated adherence practices among Caucasian women with diagnoses of hypertension from a rural area of Florida. The purpose of this study was to gain an understanding from women who had been diagnosed with hypertension about the challenges of living with and managing this chronic condition in their daily lives. Participants included Caucasian women (n = 11) recruited from a Federally Qualified Rural Health Center in Florida. Semi-structured interviews were used to collect data. Content analysis procedures were used to analyze the interviews. Emergent themes included: work stress affecting health and leading to high blood pressure; silent (")sneaky, gradual(") onset of mild to moderate symptoms leading to high blood pressure; and strong influence of family members with high blood pressure and related complications that instilled fear in participants to adhere to their prescribed treatment plan in some, or in others to non-adherence. Social support from friends and coworkers was a repeated theme supporting adherence. Minor themes associated with non-adherence included fear of potential side effects of medications, challenges of daily living caring for family, fatigue from high blood pressure and medications affecting daily work, poor food choices due to finances and availability of high sodium and fatty foods at work and home, stress and time demands affecting ability to exercise to control high blood pressure, and focus on family forgetting self-needs. Limitations of the study included a small convenience sample with findings that may not be applicable to a population of hypertensive women from different rural settings. Future nursing studies in similar populations may contribute to improved adherence practices, leading to reduced complications from poorly controlled hypertension.
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Date Issued: 2011
Identifier: CFE0004120, ucf:49100
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0004120

adherence (4)	+ -
stress (4)	+ -
biomarkers (2)	+ -
compliance (2)	+ -
coping (2)	+ -

critical care (2)	+ -
nursing education (2)	+ -
"acute respiratory distress syndrome" (1)	+ -
"prone position" (1)	+ -
ARDS (1)	+ -
Adult (1)	+ -
Africa (1)	+ -
Anxiety (1)	+ -
BiPAP (1)	+ -
Breast Cancer (1)	+ -
CABSI Bundle (1)	+ -
CASS (1)	+ -
CLABSI (1)	+ -
CLABSI Bundle (1)	+ -
CLABSI Prevention (1)	+ -
CPAP (1)	+ -
Cancer (1)	+ -
Caregiver (1)	+ -
Caucasian rural women (1)	+ -
Central line-associated bloodstream infection (1)	+ -
Cognition (1)	+ -
Cognitive Impairment (1)	+ -
Concomitance (1)	+ -
Critical care (1)	+ -
Discharge Planning (1)	+ -

ETD Collection (27)	+ -
Honors Collection (9)	+ -

University of Central Florida (36)	+ -
Sole, Mary Lou (24)	+ -
Sole, Mary (11)	+ -
Andrews, Diane (4)	+ -
Bushy, Angeline (4)	+ -

Byers, Jacqueline (3)	+ -
Conner, Norma (3)	+ -
Covelli, Maureen (3)	+ -
Norris, Anne (3)	+ -
Talbert, Steven (3)	+ -
Chase, Susan (2)	+ -
Damato-Kubiet, Leslee (2)	+ -
Gammonley, Denise (2)	+ -
Loerzel, Victoria (2)	+ -
Neff, Donna (2)	+ -
Abbott, Lionel (1)	+ -
Alhamwi, Mohamad (1)	+ -
Allen, Katherine (1)	+ -
Allred, Kelly (1)	+ -
Amato, Cody (1)	+ -
Amidei, Christina (1)	+ -
Anzalone, Patricia (1)	+ -
Beck, Laura (1)	+ -
Beile, Penney (1)	+ -
Berman, Steven (1)	+ -
Bittner, Hartmuth (1)	+ -
Bolsega, Thomas (1)	+ -
Bourgault, Annette (1)	+ -
Burfield, Allison (1)	+ -
Burr, Joyce (1)	+ -

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