Nursing Work Engagement, Professional Quality of Life, and Intent to Leave: A Structural Equation Modeling Pathway Analysis.

Background: Work engagement, professional quality of life (ProQOL), and intent to leave (ITL) significantly impact organizational behaviors and outcomes. Understanding the complex interrelationships among nurse work engagement, ProQOL, and ITL is essential for improving nurse retention, job satisfaction, and patient outcomes. In previous investigations, work engagement, ProQOL, and ITL relationships have primarily been analyzed individually.

Call to action: Blueprint for change in acute and critical care nursing.

Herein, we propose a blueprint for action to completely measure and recognize the care provided by acute and critical care nurses to be incorporated into policy that shapes and supports practice. We address the nature of nurses' work by identifying nine practice domains, hospital practice environment assumptions, and expected outcomes. Nurses' work, as a cross-system process, needs to be included in hospital-based core measures to fully reflect nurses' impact on patient care.

Delirium Screening of Patients on a Neuroscience Step-Down Unit.

This project aimed to identify patients who had experienced a stroke and were at risk for delirium earlier, and implement evidence-based protocols to reduce overall length of stay and mortality. Nurses were motivated to perform screening and implement strategies that benefit patients who had experienced acute stroke. Results suggest early identification and treatment of delirium, use of prevention strategies, and treatment of the underlying etiology can improve patient outcomes and reduce cost of care.

Rapid Handheld Continuous Electroencephalogram (EEG) Has the Potential to Detect Delirium in Older Adults.

Background: Delirium-related biochemical derangements lead to electrical changes that can be detected in electroencephalographic (EEG) patterns followed by behavioral signs and symptoms. Studies using limited lead EEG show a large difference between patients with and without delirium while discriminating delirium from other causes. Handheld rapid EEG devices may be capable of detecting delirium before symptom onset, thus providing an objective physiological method to detect delirium when it is most amenable to interventions.

A unitary caring science resilience-building model: Unifying the human caring theory and research-informed psychology and neuroscience evidence.

Resilience is the psychological capability to recover from difficulties quickly. Healthcare professionals are especially vulnerable to job-related stress and burnout. Unitary Caring Science is the framework for Watson's Human Caring Theory, providing a philosophy of practice in healthcare.

Is Perception Reality? Using Person-in-Context Simulation to Promote Empathic Understanding of Dementia Among Nurse Practitioner Students.

This one-group nonexperimental pretest/posttest repeated-measures design plus interpretative phenomenological analysis explored nurse practitioner students' perceptions of dementia using virtual simulation. Perceptions of dementia and its associated challenges differed after the simulation. A critical theme that emerged was "developing empathic understanding"; the two subthemes were "mirroring dementia behaviors" and "provoking emotions.

Fronto-temporal dementia: a case study and strategies and support for caregivers.

Fronto-temporal dementia, also known as fronto-temporal lobular degeneration, is the second most common form of early-onset dementia with a prevalence equal to Alzheimer's dementia. Behavioural variant fronto-temporal dementia primarily involves the frontal and temporal lobes of the brain. Myelination of nerve fibres in these areas allow for highly synchronized action potential timing.

Detecting Delirium Using a Physiologic Monitor.

For the past 2500 years, delirium has been described based on the presence of behavioral symptoms. Each year, as many as 1 in 5 acute care and 80% of critically ill patients develop delirium. The United States spends approximately $164 million annually to combat the associated consequences of delirium.

Methods of identifying delirium: A research protocol.

Delirium is an acute disorder affecting up to 80% of intensive care unit (ICU) patients. It is associated with a 10-fold increase in cognitive impairment, triples the rate of in-hospital mortality, and costs $164 billion annually. Delirium acutely affects attention and global cognitive function with fluctuating symptoms caused by underlying organic etiologies.

AERO: An Objective Peripheral Edema Measurement Device.

Peripheral edema is of ten assessed by medical prof essionals to gain insights about development of many patient conditions. Currently, doctors assess edema by pushing on the swollen area of a patient. The difficulty with this method is the inconsistency assessment results between different physicians due to the subjective nature of the practice.

Choosing the Right Delirium Assessment Tool.

Delirium is an increasing concern with current combined annual costs for the United States and Europe of approximately $350 billion. Although standardized definitions and diagnostic criteria exist, more than 80% of delirium in the acute care setting is overlooked or misdiagnosed. Delays in identification result in increases in severity and mortality and a reduction in quality of life.

Conducting a Device Feasibility Study.

Feasibility studies are often the first attempt researchers use to test whether a new process or part of a process is practical for use in a clinical setting or a device will provide the desired information. When conducting a device feasibility study there are several unique considerations that must be addressed. This manuscript describes the processes and considerations.

Pathophysiology Review: Seven Neurotransmitters Associated With Delirium.

Delirium affects 70% to 80% of intensive care unit patients and is associated with a 10-fold increase in rates of cognitive impairment at discharge and a 3-fold increase in mortality rates. Estimated costs are $152 billion in Medicare charges annually, 17.5 million inpatient days, and 30-day postdischarge costs of $238 726 per patient.

Monitoring peripheral edema of heart failure patients at home: Device, algorithm, and clinic study.

Continuous monitoring of heart failure (HF) patients is desirable in order to better manage their illness and reduce unnecessary hospitalization. A comprehensive cloud-based HF patient management system is proposed to collect patients' health status information and provide just-in-time intervention. To date, an HF patient edema monitoring system prototype, including the device and its algorithm, has been developed.

Design of peripheral edema measurement device for home use.

Due to improvements in cardiovascular care, more patients are living longer but ultimately developing heart failure. It is important for patients with chronic conditions, like heart failure, to self-manage and monitor their symptoms. One symptoms that can be indicative of worsening heart failure is peripheral edema.

What's Your Position? Strategies for Safely Reaching Patient Comfort Goals After Cardiac Catheterization via Femoral Approach.

Background: Patients frequently complain of back pain after cardiac catheterization, and there is a lack of evidence to guide practice regarding patient comfort while maintaining hemostasis at femoral access site after cardiac catheterization.

Objective: The aim of this study was to examine if frequent position changes affect a patient's pain level or increase incidents of bleeding in the recovery period after cardiac catheterization.

Methods: A quasi-experimental pretest/posttest design was used to evaluate a patient's reported pain levels and positioning changes during bed rest period postprocedure.

Is Nursing Care Missed? A Comparative Study of Three North Carolina Hospitals.

Results of a survey measuring frequency, types, and reasons for missed care at three acute care hospitals in North Carolina are described. Results also are compared to those of a previous, similar study in the midwestern United States.

Vulnerability of older patients in critical care.

One of the patient characteristics in the AACN Synergy Model is vulnerability. Vulnerability is defined in the model as the susceptibility to actual or potential stressors that may adversely affect patients' outcomes. The risk of vulnerability increases in older patients in critical care units.

Care redesign: a higher-quality, lower-cost model for acute care.

Objective: The aims of this study were to design, pilot, and evaluate a care team model of shared accountability on medical-surgical units.

Background: American healthcare systems must optimize professional nursing services and support staff due to economic constraints, evolving Federal regulations and increased nurse capabilities.

Methods: A redesigned model of RN-led teams with shared accountability was piloted on 3 medical/surgical units in sample hospitals for 6 months.

Ethnogeriatrics in critical care.

This article discusses the increased diversity of older adults expected to be treated in intensive care units over the next 10 years. The importance of the integration of an ethnogeriatric assessment to include ethnicity, level of acculturation, religion/spirituality, preferred interaction pattern, facilitation of communication, and physical examination constraints due to ethnicity are discussed.

Critical care visitation: nurse and family preference.

Purpose: The purpose of the study was to explore the satisfaction of patients' families and nurses with visitation guidelines in the 5 critical care units at a 435-bed acute care hospital in the southeastern part of the United States.

Problem Statement: The restriction of visitation hours for intensive care unit patients has significant implications for the health and well-being of the patient and their family. Although traditionally both facilities and staff have cited reasons to restrict family visitation, research indicates that these practices may have a detrimental effect on the overall health of the patient.

Hearing loss in older critical care patients: participation in decision making.

Older adults with hearing loss who receive care in the noisy environment of a critical care unit can be disadvantaged in their ability to understand speech, thus limiting their participation in decision making. Providing optimal outcomes for such patients can be understood through use of the American Association of Critical-Care Nurses Synergy Model. When older adults are admitted to a critical care unit, their spouses, children, and friends are in positions to participate in the patients' care.

Inpatient fall prevention: use of in-room Webcams.

Objectives: Patient falls are a challenging safety and quality issue in acute care settings. This study compared inpatient falls on medical-surgical units with and without Webcams and assessed the Morse Risk Assessment (MRA) for effectiveness in identifying fall risk.

Methods: Ten hospitals in one health system that exceeded the benchmark for falls were chosen for a 6-month study.

Engaging families to participate in care of older critical care patients.

Provision of optimal outcomes for older adults can be understood through the use of the American Association for Critical-Care Nurses Synergy Model. These outcomes can be enhanced if strategies are designed to improve the characteristics of patients and families as described in the Synergy Model. When older adults are admitted to critical care units, spouses, children, and friends are in a position to participate in care.