Benzodiazepine use in older, community-dwelling southern Californians: prevalence and clinical correlates

OBJECTIVE

To determine the use of benzodiazepines (BZDs) in an older, community-dwelling sample and to examine the sociodemographic and clinical correlates of BZD use.

DESIGN

A cross-sectional study of 1752 elderly people (aged > or = 65 y) who completed a mailed medication survey and a telephone health status survey.

PARTICIPANTS

Participants were invited to participate in a large Medicare demonstration project on prevention by their private physicians, who were also enrolled in the larger study. Participants had to be English-speaking, could not have dementia or a terminal illness, and had to give informed consent to participate in the study.

MAIN OUTCOME MEASURES

Sociodemographic and health status variables that predicted BZD use were examined. Sociodemographic variables included age, gender, ethnicity, education, and income. Health status variables included functional status, with measures of mental, social, and physical health. Influenza immunization status was used as an indicator for preventive health services use and self-reported chronic illness was used as a measure of comorbidity.

RESULTS

Twenty percent of the participants used BZDs at least twice in the past year. We found that those who used BZDs were more than twice as likely to take ten or more drugs, two-and-a-half times more likely to have difficulty falling asleep, and over twice as likely to be depressed. BZD users were also more likely to be white, to have a college education, and to have received a recent influenza shot, but were not more likely to be women when controlled for health status.

CONCLUSIONS

Further clinical research should explore the relationship between BZD use among older patients and the BZD-associated adverse clinical factors we observed, as well as the association between multiple drug use and potential adverse outcomes in older BZD users.

Socialization of Master's-Prepared Novice Nurse Faculty: Their Lived Experiences

AIM

The aim of this study was to explore the lived experience of novice nurse faculty's socialization to academia.

BACKGROUND

Socialization is a process that enables individuals to acquire the inherent roles, standards, rules, and values inherent of a group. Given the complexity of the faculty role, socialization is essential for novice nurse educators.

METHOD

A descriptive, qualitative study was conducted employing Colaizzi's phenomenological method of data analysis.

RESULTS

Eight themes emerged: lack of structure, the blind spot, distinctive experiences, acceptance and validation, continually evolving-learning as you go, the wish list, new role challenges, and self-revelation.

CONCLUSION

These findings increase our understanding of the challenges experienced by novice nursing faculty as they are socialized to their new roles. The findings can inform strategies to improve the socialization experience and faculty retention.

Stress fractures in 51 runners

A prospective study was initiated in 1976 to investigate runners who are at risk for incurring stress fractures and how these fractures can be prevented. Fifty-one runners incurred 57 stress fractures. Tibial fractures were most common (25), followed by fibula (12) and metatarsal (8). Seven runners had previously sustained stress fractures, and six developed two stress fractures simultaneously. Five women over 30 years old had pelvic stress fractures. Stress fracture development was positively correlated with the presence of pes planus, weekly training distances greater than 20 miles, hard training surfaces, and training regimen modifications. The incidence did not correlate with generalized musculoskeletal laxity or tightness. Forty-four of 51 patients had initially positive roentgenograms. Five of five bone scans were positive. The average duration of rest before running was resumed was 7.4 weeks.

Competency-Based Medication Administration and Error Reporting

BACKGROUND

Accuracy is needed with medication administration, a skill that involves rule-based habits and clinical reasoning. This pilot study investigated the use of an evidence-based checklist for accuracy with oral medication administration and error reporting among prelicensure nursing students. Checklist items were anchored in the mnemonic C-MATCH-REASON© (Client, Medication, ADRs, Time, Client History, Route, Expiration date, Amount, Site, Outcomes, Notation).

METHOD

Nineteen participants randomly assigned to crossover sequence AB or BA (A: checklist; B: no checklist) practiced simulation scenarios with embedded errors. Nursing faculty used an observation form to track error data.

RESULTS

Using the C-MATCH-REASON© checklist compared with not using the checklist supported rule adherence (p = .005), knowledge-based error reduction (p = .011), and total error reduction (p = .010). The null hypothesis was not rejected for errors found (p = .061) nor reported (p = .144), possibly due to sample size.

CONCLUSION

C-MATCH-REASON© was effective for error reduction. Study replication with a larger sample is warranted. [J Nurs Educ. 2024;63(5):320-327.].

Management and Characteristics of Embolism and Thrombosis After COVID-19 Vaccination: Scoping Review

This scoping review aims to 1) identify characteristics of participants who developed embolism and/or thrombotic event(s) after COVID-19 vaccination and 2) review the management during the new vaccine development of the unexpected event(s). This review was conducted following PRISMA for scoping review guidelines. Peer-reviewed articles were searched for studies involving participants with embolism and/or thrombotic event(s) after COVID-19 vaccination with the management described during the early phase after the approval of vaccines. The 12 studies involving 63 participants were included in this review. The majority of participants' ages ranged from 22 to 49 years. The embolism and/or thrombotic event(s) often occur within 30 days post-vaccination. Five of the included studies reported the event after receiving viral vector vaccines and suggested a vaccine-induced immune thrombotic thrombocytopenia as a plausible mechanism. Cerebral venous sinus thrombosis was the most frequently reported post-vaccination thrombosis complication. In summary, the most frequently reported characteristics and management from this review were consistent with international guidelines. Future studies are recommended to further investigate the incidence and additional potential complications to warrant the benefit and safety after receiving COVID-19 vaccine and other newly developed vaccines.

A pain management documentation tool

PURPOSE/OBJECTIVES

To describe the development, implementation, and evaluation of a tool to standardize assessment, monitoring, management, and documentation of acute and chronic pain in hospitalized patients.

DATA SOURCES

A multidisciplinary hospital committee, nursing staff, a pain consultant, published standards, and hospital standards.

DATA SYNTHESIS

A comprehensive pain flow sheet and pain protocol was developed to assess, monitor, document, and evaluate clients at risk for or with actual pain. The tool was designed to assess and document acute and chronic pain in patients with cancer.

CONCLUSIONS

Based on an initial review of quality assurance indicators, the tool has demonstrated increased consistency in documentation of pain management activities.

IMPLICATIONS FOR NURSING PRACTICE

The use of a pain assessment and management flow sheet with a pain protocol provides an organized, consistent approach that maximizes quality, cost-effective care.

Investigation of the Knoll Assessment Scale in a tertiary care facility

The purpose of this study was to assist in assessing the validity and reliability of adaptation of the Knoll Tool, Assessment of Pressure Ulcer Potential. Data were retrospectively collected from charts of a random sample of patients (n = 62) who were admitted to a tertiary care facility. Total risk scores ranged from 0 to 22 with a mean of 8.7 and a standard deviation of 6.37. The alpha for the total assessment tool was .6352 with a standardized item alpha of .5973. Discriminant analysis predicted group membership at 62.9%. Group membership was most accurately predicted in Group 1 (76.9%). Discriminant analysis using a score of 11 predicted only 46.8% of group membership, although Group 1 predicted 88.5% and Group 4 predicted 85.7%. Low predictions may be related to small sample size.

A regional survey of intravenous therapy practices

In this article, the authors share the results of a survey developed by a group of nurses in a 400-bed community hospital and distributed to 25 health care agencies throughout the northeastern New York region. The survey is comprised of six major categories, with questions pertaining to flushing and dressing protocols, types of vascular access devices used, and the availability of equipment and resources. Sixty percent of the agencies responded, including hospital, home care, hospice, and physician office settings. Major findings identified a lack of consistency in flushing and dressing protocols and in the types of equipment used. Implications for future practice will be presented along with the results of the survey.