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Title: NURSING INTERVENTIONS THAT FACILITATE END-OF-LIFE DECISION-MAKING IN PEDIATRIC ONCOLOGY.
Creator: Baeringer, Lauren, Wink, Diane, University of Central Florida
Abstract / Description: Nearly one-third of all pediatric oncology patients die from their disease, so nurses need to have an evidence-based standard of practice to guide their role in end-of-life decision-making. The purpose of this integrative review is to analyze current research on end-of-life decision-making within pediatric oncology to create a practice guideline for nurses working with this patient population. Eleven studies were examined to identify nursing interventions regarding the role of the nurse in...
Show moreNearly one-third of all pediatric oncology patients die from their disease, so nurses need to have an evidence-based standard of practice to guide their role in end-of-life decision-making. The purpose of this integrative review is to analyze current research on end-of-life decision-making within pediatric oncology to create a practice guideline for nurses working with this patient population. Eleven studies were examined to identify nursing interventions regarding the role of the nurse in end-of-life care, the role of the nurse in end-of-life decision-making, parent involvement in end-of-life decision-making, and child involvement in end-of-life decision-making, including the child's ability to participate in end-of-life decision-making. Based on the findings, the researcher identified several interventions that can be used by nurses to facilitate end-of-life discussion and decision-making that includes both parent and, when appropriate, the child.
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Date Issued: 2013
Identifier: CFH0004443, ucf:45081
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFH0004443

Title: BARRIERS AFFECTING COMPLIANCE WITH THE IMPLEMENTATION OF EARLY GOAL DIRECTED THERAPY IN THE EMERGENCY DEPARTMENT.
Creator: Castro, Ivan, Blackwell, Christopher, University of Central Florida
Abstract / Description: Early Goal Directed Therapy (EGDT) has been thoroughly researched and clinically supported to be effective at lowering morbidity and mortality associated with severe sepsis and septic shock. Due to the strengths of its efficacy, it has been integrated as an essential component of the Surviving Sepsis Campaign. However, very few studies have explored the barriers that affect compliance of the protocol in actual practice. The purpose of this study was to synthesize current research findings...
Show moreEarly Goal Directed Therapy (EGDT) has been thoroughly researched and clinically supported to be effective at lowering morbidity and mortality associated with severe sepsis and septic shock. Due to the strengths of its efficacy, it has been integrated as an essential component of the Surviving Sepsis Campaign. However, very few studies have explored the barriers that affect compliance of the protocol in actual practice. The purpose of this study was to synthesize current research findings regarding nursing barriers associated with EGDT. This research was limited to studies performed in the United States between 2003-2012, with patients at least 18 years old, and with data obtained from studies conducted within emergency departments (EDs) only. These findings may serve to help increase the compliance rate with the protocol among nurses in the ED. Findings indicated that compliance rates were mostly affected by two major barriers: 1) Lack of knowledge regarding the presentation and management of sepsis and septic shock, and 2)Lack of resources in the ED to perform the protocol to its full potential. Limitations of the review noted were that most research studies used were in major academic hospitals which limited the generalizability of the findings to other hospital settings. Nursing education should emphasize early recognition and aggressive treatment of sepsis. Future research should focus on addressing the most efficient ways to educate nurses on sepsis presentation and management and the ways these can be implemented in practice.
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Date Issued: 2013
Identifier: CFH0004420, ucf:45095
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFH0004420

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: NURSING INTERVENTIONS IN THE CARE OF PATIENTS UNDERGOING INDUCED HYPOTHERMIA.
Creator: Zimmerman, Angela, Amidei, Christina, University of Central Florida
Abstract / Description: Use of induced hypothermia for the purpose of lowering intracranial pressure and preserving neuronal function has increased as research data reveals a trend of positive outcomes in patients treated with this therapy. Recently induced hypothermia following cardiac arrest due to ventricular fibrillation has been deemed successful. Current research has expanded to evaluate the effectiveness of induced hypothermia as a treatment modality for severe stroke and head trauma. In spite of its efficacy...
Show moreUse of induced hypothermia for the purpose of lowering intracranial pressure and preserving neuronal function has increased as research data reveals a trend of positive outcomes in patients treated with this therapy. Recently induced hypothermia following cardiac arrest due to ventricular fibrillation has been deemed successful. Current research has expanded to evaluate the effectiveness of induced hypothermia as a treatment modality for severe stroke and head trauma. In spite of its efficacy, complications exist with this treatment modality. The purpose of this literature review is to examine potential complications secondary to induced hypothermia and highlight the nurse's role in managing patient care. At the present, patient protocols for induced hypothermia are lacking. The success of treatment is largely dependent on the skill of the healthcare team to prevent further harm and enhance therapeutic outcomes by providing astute assessment and management of complications in patients undergoing induced hypothermia. The desired outcome of this review is to promote integration of research in the development of evidence-based protocols for induced hypothermia.
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Date Issued: 2011
Identifier: CFH0003836, ucf:44718
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFH0003836

Title: THE USE OF MOBILE APPLICATIONS IN PREVENTIVE CARE AND HEALTH-RELATED CONDITIONS: A REVIEW OF THE LITERATURE.
Creator: Ringer, Naomi, D'Amato-Kubiet, Leslee, University of Central Florida
Abstract / Description: The purpose of this review of literature was to understand the role of mobile device applications in health related conditions and to analyze their effects on health outcomes related to the management of chronic illnesses. Implications for future use of applications in client-centered care and interpretation of the data by health care providers was also explored. Peer-reviewed, English-language research articles published from 2008 to present were included for synthesis. Study results...
Show moreThe purpose of this review of literature was to understand the role of mobile device applications in health related conditions and to analyze their effects on health outcomes related to the management of chronic illnesses. Implications for future use of applications in client-centered care and interpretation of the data by health care providers was also explored. Peer-reviewed, English-language research articles published from 2008 to present were included for synthesis. Study results revealed positive outcomes when health-related mobile applications were used in practice and support clinicians' use of mobile applications as a tool for monitoring symptoms and communicating with individuals. The literature indicated nurses play a significant role in providing feedback, which reinforces self-care strategies and adherence, with the potential for improving outcomes. Additional research is needed to evaluate the long-term effects of applications on patient outcomes, nurses' perspectives, and feasibility of implementation into practice.
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Date Issued: 2014
Identifier: CFH0004660, ucf:45280
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFH0004660

Title: HEALTH-CARE SEEKING BEHAVIORS OF PUERTO RICANS WITH DIABETES MELLITUS WHO LIVE IN SOUTH FLORIDA: AN EXPLORATORY STUDY.
Creator: Gonzalez, Laura, Bushy, Angeline, University of Central Florida
Abstract / Description: ABSTRACT Latinos are the fastest growing minority population in the United States (U.S.) and have the worst access to health care of any ethnic group. The chronic disease of diabetes is twice as common in adult Latinos as in non-Latino whites, and the risk of death related to diabetes is twofold. Reasons for this disparity have yet to be clearly identified. This study had two purposes: 1) to explore cultural beliefs regarding health-care seeking behaviors in Puerto Ricans with diabetes who...
Show moreABSTRACT Latinos are the fastest growing minority population in the United States (U.S.) and have the worst access to health care of any ethnic group. The chronic disease of diabetes is twice as common in adult Latinos as in non-Latino whites, and the risk of death related to diabetes is twofold. Reasons for this disparity have yet to be clearly identified. This study had two purposes: 1) to explore cultural beliefs regarding health-care seeking behaviors in Puerto Ricans with diabetes who live in South Florida; and 2) to examine Puerto Ricans' perceptions about their health-care providers. The cultural phenomena of interest were familism, religiosity, spirituality, use of ethnomedicine, and perception of ethnic concordance of health-care provider. Numerous studies have examined these phenomena with other Latino groups, but none have specifically focused on Puerto Ricans. An overarching goal of the study was to contribute to the knowledge base on a particular health disparity--diabetes. Using a narrative inquiry approach, a purposive sample of self-identified Puerto Ricans with diabetes (N = 12) were recruited from six sites in a South Florida city. Data were obtained using a pencil-and-paper demographic instrument, the Short Acculturation Scale to determine language preference of Spanish or English, and a personal interview using a semi-structured, ten-item interview guide. Subjects gave written informed consent for participation, and all data were coded to ensure confidentiality. The personal interviews were tape recorded and transcribed verbatim. Interviews completed in Spanish were translated to English and transcribed. Using content analyses techniques, transcribed narratives were analyzed for content and thematic emergence. iii The findings revealed that familism was an important consideration in health-care seeking behaviors. Traditional gender role expectations, coupled with caregiver burdens, deterred some participants from seeking care even when care was needed. Religiosity and spirituality did not influence decision-making but did have a role in coping with the chronic disease. While participants were aware of culturally based ethnomedicine, they preferred Western medicine for the treatment of their diabetes. They also had a preference for a health-care provider who was ethnically concordant. Serendipitous findings that emerged in the analyses included the casual attitude of several participants about their diabetic status and reports of depressive-like symptoms among most of the women. Health-care providers need to take into consideration the cultural and linguistic preferences of Puerto Ricans to develop an appropriate and effective treatment plan. Discrepancies between the health-care providers and the clients' systems must be reconciled to improve adherence to evidence-based treatment.
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Date Issued: 2008
Identifier: CFE0002018, ucf:47631
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0002018

Title: The conceptual field of proportional reasoning researched through the lived experiences of nurses.
Creator: Deichert, Deana, Dixon, Juli, Haciomeroglu, Erhan, Andreasen, Janet, Hunt, Debra, University of Central Florida
Abstract / Description: Proportional reasoning instruction is prevalent in elementary, secondary, and post-secondary schooling. The concept of proportional reasoning is used in a variety of contexts for solving real-world problems. One of these contexts is the solving of dosage calculation proportional problems in the healthcare field. On the job, nurses perform drug dosage calculations which carry fatal consequences. As a result, nursing students are required to meet minimum competencies in solving proportion...
Show moreProportional reasoning instruction is prevalent in elementary, secondary, and post-secondary schooling. The concept of proportional reasoning is used in a variety of contexts for solving real-world problems. One of these contexts is the solving of dosage calculation proportional problems in the healthcare field. On the job, nurses perform drug dosage calculations which carry fatal consequences. As a result, nursing students are required to meet minimum competencies in solving proportion problems. The goal of this research is to describe the lived experiences of nurses in connection to their use of proportional reasoning in order to impact instruction of the procedures used to solve these problems. The research begins by clarifying and defining the conceptual field of proportional reasoning. Utilizing Vergnaud's theory of conceptual fields and synthesizing the differing organizational frameworks used in the literature on proportional reasoning, the concept is organized and explicated into three components: concepts, procedures, and situations. Through the lens of this organizational structure, data from 44 registered nurses who completed a dosage calculation proportion survey were analyzed and connected to the framework of the conceptual field of proportional reasoning. Four nurses were chosen as a focus of in-depth study based upon their procedural strategies and ability to vividly describe their experiences. These qualitative results are synthesized to describe the lived experiences of nurses related to their education and use of proportional reasoning.Procedural strategies that are supported by textbooks, instruction, and practice are developed and defined. Descriptive statistics show the distribution of procedures used by nurses on a five question dosage calculation survey. The most common procedures used are the nursing formula, cross products, and dimensional analysis. These procedures correspond to the predominate procedures found in nursing dosage calculation texts. Instructional implications focus on the transition between elementary and secondary multiplicative structures, the confusion between equality and proportionality, and the difficulty that like quantities present in dealing with proportions.
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Date Issued: 2014
Identifier: CFE0005781, ucf:50058
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0005781

Title: Impact of Interruption Frequency on Nurses' Performance, Satisfaction, and Cognition During Patient-Controlled Analgesia Use in the Simulated Setting.
Creator: Campoe, Kristi, Talbert, Steven, Sole, Mary Lou, Andrews, Diane, Jentsch, Florian, University of Central Florida
Abstract / Description: Problem: Interruption during medication administration is a significant patient safety concern within health care, especially during the administration of high risk medications in nursing. Patient-controlled analgesia (PCA) devices are frequently associated with adverse events and have a four-fold increased risk of patient injury compared to non-PCA related adverse events. While the nature and frequency of interruptions have been established for nurses' medication processes, the impact of...
Show moreProblem: Interruption during medication administration is a significant patient safety concern within health care, especially during the administration of high risk medications in nursing. Patient-controlled analgesia (PCA) devices are frequently associated with adverse events and have a four-fold increased risk of patient injury compared to non-PCA related adverse events. While the nature and frequency of interruptions have been established for nurses' medication processes, the impact of interruption frequency on nurses' PCA interaction has not been fully measured or described.Purpose: The purposes of this study were to quantify the impact of interruption frequency on registered nurses' (RN) performance, satisfaction, and cognitive workload during PCA interaction, and to determine nurses' perceptions of the impact of interruption frequency.Methods: This study employed a mixed-method design. First, an experimental repeated measures design was used to quantify the impact of interruption frequency on a purposive sample of nine medical-surgical RNs. The RNs completed PCA programming tasks in a simulated laboratory nursing environment for each of four conditions where interruption frequency was pre-determined. Four established human factors usability measures were completed for each of the four test conditions. The research questions were answered using repeated measures analysis of variance with (RM-ANOVA), McNamar's test, and Friedman's test. After each experiment, semi-structured interviews were used to collect data that were analyzed using inductive qualitative content analysis to determine RNs' perceptions of the impact of interruption frequency. Results: Results of the RM-ANOVA were significant for the main effect of interruption frequency on efficiency F(3,24)=9.592, p = .000. McNemar's test did not show significance for the impact of interruption frequency on effectiveness (accuracy). Friedman test showed participant satisfaction was significantly impacted by interruption frequency (x2=9.47, df=3, p=0.024). Friedman test showed no significance for the main effect of interruption frequency on cognitive workload scores by condition type (x2=1.88, df=3, p=0.599). Results of the qualitative content analysis revealed two main categories to describe nurses' perception of interruption frequency: the nature of interruptions and nurses' reaction to the interrupted work environment.Discussion/Implications: The results suggested that interruption frequency significantly affected task completion time and satisfaction for participants but not participant accuracy or cognitive workload. A high error rate during PCA programming tasks indicated the need to evaluate the conditions in which RNs complete PCA programming as each error presents potential risk of patient harm. RNs' described the impact of interruption frequency as having a negative impact on the work environment and subsequently implement compensating strategies to counterbalance interruptions. RNs' perceived that patient safety was negatively impacted by frequent interruption. RNs experienced negative intrapersonal consequences as a results of frequent interruption. Additional study is needed to better understand the impact of interruption frequency on RNs' performance accuracy and cognitive workload.
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Date Issued: 2015
Identifier: CFE0005770, ucf:50099
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0005770

Title: INJECTION TECHNIQUES OF SUBCUTANEOUS ANTICOAGULANT THERAPIES.
Creator: Morissette, Leah, Desmarais, Paul, University of Central Florida
Abstract / Description: Subcutaneous anticoagulant medications like Heparin and Low-Molecular Weight Heparin are injections that readily cause bruising, pain, induration, and hematoma formation at the injection site. It is known that these adverse reactions can be correlated to the technique used to administer these medications; however, there is no established technique that reduces bruising, pain, induration, and hematoma formation at the site. Currently, the only protocol for subcutaneous Heparin and Low...
Show moreSubcutaneous anticoagulant medications like Heparin and Low-Molecular Weight Heparin are injections that readily cause bruising, pain, induration, and hematoma formation at the injection site. It is known that these adverse reactions can be correlated to the technique used to administer these medications; however, there is no established technique that reduces bruising, pain, induration, and hematoma formation at the site. Currently, the only protocol for subcutaneous Heparin and Low-Molecular Weight Heparin is that it is to be administered subcutaneously in the abdomen and when using a prefilled syringe, the air bubble should not be removed. The purpose of this study was to identify current nursing practice for the administration of these medications and to compare the results to researched techniques that resulted in less adverse site reactions. A total of 33 participants were recruited. The survey targeted six researched techniques found, after a comprehensive literature review, to have reduced site adverse effects associated with subcutaneous Heparin and Low-Molecular Weight Heparin. After completing the survey, it was found that current practice does not reflect techniques researched to reduce bruising, pain, induration, and hematoma formation at the site. In fact, very few completed one of the six research techniques that were questioned, which included: a two minute application of a cold compress/pack before and/or after the injection, an injection duration lasting 30 seconds, slow removal of the needle over five seconds, application of pressure after the injection for a minimum of 30 seconds, use of a hot pack/compress after the injection, and the use of a3 mL syringe. It was also found that there were inconsistencies in techniques that have been previously established as current protocol for these medications.
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Date Issued: 2015
Identifier: CFH0004733, ucf:45390
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFH0004733

Title: SUPPORT SYSTEMS IN ADOLESCENTS WITH TYPE 1 DIABETES MELLITUS AND THE RELATIONSHIP TO DIABETES-RELATED STRESS, CONFLICT, AND METABOLIC CONTROL.
Creator: Foarde, Samuel, LaManna, Jacqueline, University of Central Florida
Abstract / Description: The purpose of this integrated review of the literature was to explore the effects of social support on diabetes-related stress, conflict, and metabolic control in adolescents with type 1 diabetes mellitus (T1DM). Social support was examined in four subgroups: adolescents with T1DM, family caregivers, peers, and teachers. Relevant findings in the literature revealed a significant deficiency of research devoted to adolescent males with diabetes as well as fathers as primary and secondary...
Show moreThe purpose of this integrated review of the literature was to explore the effects of social support on diabetes-related stress, conflict, and metabolic control in adolescents with type 1 diabetes mellitus (T1DM). Social support was examined in four subgroups: adolescents with T1DM, family caregivers, peers, and teachers. Relevant findings in the literature revealed a significant deficiency of research devoted to adolescent males with diabetes as well as fathers as primary and secondary caregivers. Studies highlighted the importance of fostering autonomy and positive self-image in adolescents with T1DM and described effective interventions to improve diabetes-related stress, reduce disease-related conflict, and improve metabolic control. Findings suggested that nurses caring for adolescents with T1DM and their families should foster positive, open communication, while identifying barriers to problem solving, coping, stress, and optimal glycemic control. Interventions that educate caregivers and peers on how to better communicate and provide support are critical in fostering positive psychological and physiological outcomes in the adolescent with T1DM. The findings of this study may provide guidance in the way that nurses assess, identify, and counsel adolescents with TIDM regarding their disease management and access to support systems.
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Date Issued: 2013
Identifier: CFH0004324, ucf:45057
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFH0004324

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