The effects of music on pain and anxiety during screening mammography

One in four women who are diagnosed with breast cancer die annually, and the single most important way to prevent this is early detection; therefore, women older than 40 years should have an annual screening mammography. Many barriers have been reported that prevent compliance with this recommendation, including lack of insurance, fear, anxiety, pain, worry, and mistrust of the medical community. Nurses are in a position to use creative interventions, such as music therapy, to help minimize barriers. Although this study did not show that music therapy during screening mammograms decreased the amount of pain that the participants experienced, it did suggest that music therapy has the potential to decrease the amount of anxiety. Assisting patients in decreasing anxiety reduces barriers for screening mammography. The literature does suggest that music is a distraction for many populations of patients; however, when patients are faced with the possible diagnosis of breast cancer, it may be difficult to find an intervention to distract a woman's mind, which was supported by the findings of this study.

Assessing for Occult Suicidality at Triage: Experiences of Emergency Nurses

INTRODUCTION

Screening for suicidality is a critical nursing function at the initial ED encounter. Suicide is the tenth leading cause of death in the United States, and a substantial percentage of people who die by suicide present for health care in the year before their deaths. The emergency department provides health care professionals with a critical opportunity to identify patients at risk for suicide and intervene appropriately.

METHODS

Qualitative exploratory study using focus-group data.

FINDINGS

Effective and accurate suicidality assessment occurs not by asking a single question but also with the assessment of patient behaviors and presentation (appearance, hygiene, etc). When emergency nurses suspected occult suicidality, additional actions (finding private space, keeping patients safe, and passing on information), took priority.

DISCUSSION

The Joint Commission recommends using clinical judgment tools for the final determination of safety for a patient at suspected risk of suicide, as research findings suggest that a screening tool can identify persons at risk for suicide more reliably than a clinician's personal judgment. Our participants report that when they assessed suicide risk at triage, it was usually by asking a single question such as "Do you have thoughts or plans to harm yourself?" and they expressed concern about the effectiveness of doing so. Participants described their efforts to improve suicide screening across the duration of the patient's ED stay through an iterative process of assessment that included further probing and eliciting, evaluating, and reacting to the patient's response.

Triage Decisions Involving Pregnancy-Capable Patients: Educational Deficits and Emergency Nurses' Perceptions of Risk

BACKGROUND

In areas where obstetric services are not available, emergency departments often become the default for unplanned obstetric care, yet emergency nurses are not universally trained in the identification and treatment of obstetric emergencies. The purpose of this study was to explore emergency nurses' perception of acuity in the triage of pregnant or postpartum patients presenting to the emergency department with high-risk complaints and to identify facilitators and challenges to the accurate identification and treatment of these patients.

METHOD

A mixed-methods study was conducted using chart review data (N = 12,766) and focus group data (N = 39) from five emergency departments in the eastern United States.

RESULTS

In 86.5% of cases, pregnancy status was not documented. Ninety-four percent of pregnant patients with a systolic blood pressure over 140 mmHg were under-triaged. The overall theme of the qualitative data was acuity blindness, with identified barriers to assessment that included educational needs and triage processes and workflow issues.

CONCLUSION

There are significant knowledge deficits in the care of patients presenting with high-risk conditions associated with pregnancy. [J Contin Educ Nurs. 2021;52(1):21-29.].

Developing an emergency department based Special Operations Team: Robert Wood Johnson University Hospital's experience

Robert Wood Johnson University Hospital initiated an emergency department based Special Operations Team as a way to help prepare staff for the care of hazardous material incidents (HAZMAT) victims and the unexpected consequences of a mass casualty incident. The team evolved over a period of 5 years and is now able to provide significant educational offerings, policy and procedure review and participation in extensive planning efforts in the hospital and community. This article will review the process and present future goals of the team.

Reducing Central Line-Associated Bloodstream Infections on Inpatient Oncology Units Using Peer Review

The purpose of this article is to describe a peer-to-peer program and the outcomes of interventions to reduce the incidence of central line-associated bloodstream infections in patients in bone marrow transplantation, medical, and surgical oncology units. The article reviews the process and describes tools used to achieve success in a Magnet®-designated academic medical center.

Management of the patient with complex orthopaedic fractures

Patients who sustain complex orthopaedic fractures related to a traumatic event can develop devastating complications. Patients who sustain open fractures are at greater risk for complications such as wound and systemic infections and nonunion of the fracture itself. This article describes the management of open complex extremity fractures through a case study approach.

2018 Visionary Leader Lori A. Colineri

The following manuscript is the winning 2018 Richard Hader Visionary Leader Award entry submitted to Nursing Management in recognition of Lori A. Colineri, DNP, RN, NEA-BC, CNO of the Southern Region for RWJBarnabas Health (RWJBH). Lori was formally recognized for her achievements before the Keynote Address on September 26 at Congress2018 in Lake Buena Vista, Fla., where she received the award, sponsored by Hackensack Meridian Health.

Perceived Dying Experience and Compassion in Oncology Patients and Nurses Following Implementation of the Forever Heart Program: A Pilot Study

This pilot study explored the feasibility of a Forever Heart Program and the impact it has on oncology nurses' perception of the dying experience and their own compassion competence. Guided by Kubler-Ross's framework, the Forever Heart Program consists of a gemstone keepsake offered to patients and families during end-of-life care to support the grieving process. A mixed-methods approach utilized pretest/posttest design in a convenience sample of oncology nurses in an academic medical center over a 3-month period. The study collected demographics, Compassion Competence Scale scores, and qualitative responses via survey and an optional focus group. Twenty-five nurses participated in the presurvey, and 14 participated in the postsurvey. Seven nurses attended the focus groups. Overall, compassion competence scores were high, both pre and post. Qualitative themes included appreciation, connection, positive nursing, patient and family experience/relationships, grieving guidance, program benefits, and process opportunities. Although the study did not show statistically significant differences in compassion, it did show program feasibility and the potential positive impact that keepsakes like the Forever Heart Program can have on nurses and their role in the dying experience.

Decreasing community acquired CLABSI: Creating a new infection prevention bundle for management of the pediatric patient discharged with a central line

BACKGROUND

Central line-associated blood stream infections (CLABSIs) can contribute to significant morbidity and mortality. The aim of this improvement project was to decrease CLABSIs by creating an Outpatient Pediatric Central Line Education Bundle and standardizing the education and supplies needed for pediatric patients and families to safely be discharged home with an accessed central line.

METHODS

The Plan Do Study Act method of quality improvement was used for this project. Patient and family interviews were conducted, and the Family and Youth Advisory councils were consulted. Assessment surveys utilizing a 5-point Likert scale were given to patients before and after the implementation to evaluate the effectiveness of the intervention.

RESULTS

Following the implementation zero community CLABSIs have been reported.

DISCUSSION

This collaborative project provides the necessary education and resources to manage and streamline central line care in the home and may help prevent complications such as CLABSI.

Patient recall of therapeutic paralysis in a surgical critical care unit

STUDY OBJECTIVE

To investigate patient recall of therapeutic paralysis (TP) in a surgical critical care unit.

DESIGN

Prospectively applied structured interview of patients undergoing TP over 18 months.

SETTING

Surgical critical care unit with 27 beds at a tertiary care university teaching hospital.

PATIENTS

Forty patients admitted for postoperative care after coronary artery bypass graft surgery, trauma, or gastrointestinal surgery.

INTERVENTIONS

Patients received TP and concurrent sedation with benzodiazepines, propofol, and narcotics.

MEASUREMENTS AND MAIN RESULTS

After the end of TP patients were asked to recall the experience, and their responses were ranked on a four-point ordinal scale. Four of 11 patients recalled mostly negative events and experiences with TP, such as sleeplessness, discomfort, pain, anxiety, and inconsistent caregiver communication. All patients with recall experienced fear, anxiety, and sleeplessness. Single-drug therapy with propofol and inadequate benzodiazepine dosing were linked to patient recall.

CONCLUSIONS

Patient recollection from TP may be more common than appreciated and is generally unpleasant. Adequate dosing with benzodiazepines and narcotics is warranted to prevent recall and discomfort.