vol. 87 • number 3 august, september, october 2018 ... · vol. 87 • number 3 august, september,...
TRANSCRIPT
2018 ANA Hill Day and Membership Assembly Washington, DC June 21-23, 2018
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THE OFFICIAL PUBLICATION OF THE NORTH DAKOTA NURSES ASSOCIATIONSent to all North Dakota Nurses courtesy of the North Dakota Nurses Association (NDNA). Receiving this newsletter
does not mean that you are a member of NDNA. To join please go to www.ndna.org and click on “Join.” Quarterly publication direct mailed to approximately 16,000 RNs and LPNs in North Dakota
Vol. 87 • Number 3 August, September, October 2018
President’s Message
Tessa Johnson
Tessa Johnson, MSN, BSN, RN
Greetings North Dakota Nurses! Did you know ANA had deemed this year ‘The year of Advocacy’? We know advocacy is defined as the act of pleading for or actively supporting a cause or proposal, but what we need to think about is what does that mean to us as nurses and more importantly to the patients that we serve. According to Zolnierek, (2012) “The American Nurses Association’s Code of Ethics for Nurses and Scope and Standards of Nursing Practice clearly identify nurses’ ethical and professional responsibility for protecting the safety and rights of their patients; State nursing practice acts may establish a legal duty for patient advocacy as well” (p.1). We all need to consider if we are doing our part on a state level to fulfill that professional responsibility that we carry. Advocacy can mean many things in many different ways. Advocacy means using one’s position to support, protect, or speak out for the rights and interests of another. Nurses have long claimed patient advocacy as fundamental to their practice. Since we have made this commitment to advocacy, others care what we have to say and that is why we need to speak to be heard.
There are many ways that we can speak to be heard. One of those ways is to start on a local level. There are so many things we can do here in our home state in order to be heard. One of those ways is by joining NDNA/ANA and getting involved. Luckily NDNA has a voice at the table with the legislatures in our state as well as other groups such as the Center for Nursing. By becoming a member of your local professional organization, you can have the opportunity to be heard and support our local platform of many nursing issues that arise. We are the experts and our legislators want to hear what we have to
say. Of course, we all know that being an advocate isn’t always easy. It takes dedication, passion and love for our profession to continue to push forward. One misconception of nurses who do direct patient care is that they don’t have a voice; this couldn’t be more wrong. Direct-care nurses are poised especially well to identify and speak up about conditions that may result in near misses or actual adverse events. Cultures of safety promote and encourage staff to raise issues, yet most workplace cultures are imperfect, and nurses may face challenges in their advocacy efforts (Zolniere, P.1). This is when we find an internal struggle about what has been normal to us in some environment and when we know we need to speak up and make a change. One of the benefits of being involved in a group such as a professional association is you have support and a unified voice. We all know that nurses may fear retaliation and lack knowledge about established processes and protections for patient advocacy activities. Raising a concern disrupts the status quo and challenges the organization to confront problems. This, my friends, is EXACTLY what we need; we must challenge and disrupt the status quo to ensure we are always advocating for the best possible care for the patients we serve. I encourage you all to find a way that works for you to get involved. Be well, we need all of you!!!
Zolnierek, C. (2012). Speak to be Heard. American Nurse Today, 7(10), 1-3. Retrieved June 13, 2018, from https://www.americannursetoday.com/speak-to-be-heard-effective-nurse-advocacy/.
Speak to be Heard
ANA MemberBenefits
ANA Hill Day & Membership Assembly
SAVE THE DATE!
Conference in Bismarck
2018 Membership Assembly in Review:Experiences While Representing the NDNA
NDNA President Tessa Johnson and NDNA Membership Assembly Representative Tammy Buchholz attended the 2018 ANA Hill Day and Membership Assembly. The 2018 Membership Assembly activities began with an 8:00 a.m. meeting, Thursday, June 21st in Washington, DC. The meeting provided a federal legislative overview and key talking points for nurse
members to share with their state senators and representatives during the day’s scheduled meetings.
Various speakers addressed the group including ANA President Pam Cipriano, Michelle Artz, ANA Director of Government Affairs, Samuel Hewitt, ANA Senior Associate Director, Federal
2018 Hill Day continued on page 4
current resident or
Presort StandardUS Postage
PAIDPermit #14
Princeton, MN55371
Page 2 The North Dakota Nurse August, September, October 2018
The North Dakota Nurse Official Publication of:
North Dakota Nurses Association
General Contact Information:701-335-6376 (NDRN)
OfficersPresident: Vice President–Tessa Johnson, MSN, RN Membership [email protected] Open Position
Vice President– Vice President–Communications Government Relations Kayla Kaizer, BSN, RN Kristin Roers, MS, RN, [email protected] [email protected]
Vice President– Vice President–Finance Practice, Education,DeeAnna Opstedahl, Administration, ResearchMSN, RN, CNOR Sherry Burg, MBA, RN [email protected]
Director at Large– Executive Director:New Graduate Sherri Miller BSN, RNOpen Position [email protected]
Published quarterly: February, May, August and November for the North Dakota Nurses Association, a constituent member of the American Nurses Association, 1515 Burnt Boat Dr. Suite C #325, Bismarck, ND 58503. Copy due four weeks prior to month of publication. For advertising rates and information, please contact Arthur L. Davis Publishing Agency, Inc., 517 Washington Street, PO Box 216, Cedar Falls, Iowa 50613, (800) 626-4081, [email protected]. NDNA and the Arthur L. Davis Publishing Agency, Inc. reserve the right to reject any advertisement. Responsibility for errors in advertising is limited to corrections in the next issue or refund of price of advertisement.
Acceptance of advertising does not imply endorsement or approval by the North Dakota Nurses Association of products advertised, the advertisers, or the claims made. Rejection of an advertisement does not imply a product offered for advertising is without merit, or that the manufacturer lacks integrity, or that this association disapproves of the product or its use. NDNA and the Arthur L. Davis Publishing Agency, Inc. shall not be held liable for any consequences resulting from purchase or use of an advertiser’s product. Articles appearing in this publication express the opinions of the authors; they do not necessarily reflect views of the staff, board, or membership of NDNA or those of the national or local associations.
Writing for Publication in The North Dakota Nurse
The North Dakota Nurse accepts manuscripts for publication on a variety of topics related to nursing. Manuscripts should be double spaced and submitted electronically in MS Word to [email protected]. Please write North Dakota Nurse article in the address line. Articles are peer reviewed and edited by the RN volunteers at NDNA. Deadlines for submission of material for 2018 North Dakota Nurse are 9/10/18 and 12/10/18.
Nurses are strongly encouraged to contribute to the profession by publishing evidence based articles. If you have an idea, but don’t know how or where to start, contact one of the NDNA Board Members.
The North Dakota Nurse is one communication vehicle for nurses in North Dakota.
Raise your voice.
The Vision and Mission of the North Dakota Nurses Association
Vision: North Dakota Nurses Association, a professional organization for Nurses, is the voice of Nursing in North Dakota.
Mission: The Mission of the North Dakota Nurses Association is to promote the professional development of nurses and enhance health care for all through practice, education, research and development of public policy.
Welcome New Members
Vickie Ireland
Betsy Kanz
Kathleen Rogan
Jessica Vos
Ashley Brew
Eva Cabato
Kami Lehn
Shaun Seibold
Renata Hegle
Jocelyn Klein
Delta Carvalho-Anderson
How to submit an article for The North Dakota Nurse!The North Dakota Nurses Association accepts articles on topics related to nursing. We also accept student articles
& evidence based practice articles. All articles are peer reviewed and edited by
NDNA volunteers.
Deadline for submission for the next issue is 9/10/2018. Send your submissions to [email protected].
If you or someone you know would make a great candidate for the NDNA Board of Directors let us know! We are now accepting nominations in the following positions for the 2019-2020 term:
President Spokesperson for NDNA; liaison
between state and national office (ANA); provides leadership for the state association
Vice President of Practice, Education, Administration & Research
Coordinate practice, education, administration and research activities & initiatives
Director at Large: New Graduate Coordinate with the VP of
Membership to develop recruitment strategies & serve as a liaison with NSAND
Please see NDNA website for more information at www.ndna.org.
Contact the following individuals on the current nominating committee to serve in any of the above volunteer positions.
Jami Falk RN CNML MSSL [email protected]
Karla Haug MS, RN [email protected]
All candidates must be a member in good standing with NDNA and will need to complete a "Consent to Serve" form.
The last day of nominations will be August 23rd, 2018. Elections will occur electronically following nominations. Installation of new board members will take place at the NDNA Annual Meeting in Bismarck on September 27th.
Nominations wanted for NDNA
Board of Directors!
The North Dakota Department of Health has employment opportunities for REGISTERED NURSES, DIETITIANS
AND QUALIFIED INTELLECTUAL DISABILITIES PROFESSIONALS (QIDP) as a Health Facilities Surveyor.
How would you like every weekend to be a three-day weekend plus have ten paid holidays each year?
Join our team of dedicated nurses and dieticians and you will travel across our great state to assure compliance with state and federal standards.
Overnight travel required and you will be reimbursed for your food & lodging expenses.
Here’s a chance to make a difference in a unique way using your education and experience.
As a state employee, you will enjoy our excellent benefits package and a four-day work week.
Immediate Openings AvailableThe position will remain open until filled.
Competitive Salary
Please contact:Bruce Pritschet, Division of Health Facilities
600 E. Boulevard Ave Dept 301Bismarck, ND 58505-0200 | 701.328.2352
Website: https://www.cnd.nd.gov/psc/recruit/EMPLOYEE/HRMS/c/HRS_HRAM.HRS_APP_SCHJOB.GBL?
An Equal Opportunity Employer
Editor’s Note The article “Heart Disease
Readmission” on page 10 of the May 2018 edition of the North Dakota Nurse was written by Allison Sadowsky MSN, RN. Our apologies that we did not catch this during proofing to give you credit in the May edition.
August, September, October 2018 The North Dakota Nurse Page 3
Itohan Agbenin, Mackenzie Hedge, Curt Koopmeiners, and Lauren Spaeth;
BA Nursing Students, with Dr. Jennifer Bailey DeJong, Faculty Mentor, PhD, FNP-BC,
Associate Professor of Nursing, Concordia College, Moorhead, MN
IntroductionThe aim of this systematic review was to
investigate and synthesize the current evidence on the effectiveness of somatostatin analogues on patients diagnosed with Cushing’s Disease (CD).
MethodA literature search was completed using
four research databases with the search criteria using the terms “Cushing’s Disease,” “Somatostatin” and “Analogues.” The database search strategy yielded a total of 1,454 citations. The results were then narrowed to 14 studies when the authors included the criteria of: published after 2012, full text, and English language. Each author evaluated an equal number of articles for the review.
ResultsFindings suggest that the medical
management of CD with somatostatin analogs
to be beneficial in patients for whom surgery is not an option or has not been efficacious. Pasireotide was shown to be effective in the treatment of CD. Overall, outcomes were positive. They included: decreased serum and urine cortisol levels, decreased mean plasma corticotropin level, improved body weight, blood pressure, and increased satisfaction with quality of life. However, negative outcomes were also reported. Clients reported side effects while taking somatostatin analogues, which included: abdominal pain, GI disturbances, and loss of glycemic control and rise in glycated hemoglobin. All of the studies used sample sizes of less than 200 patients. The research design varied between randomized double-blind studies, case studies, and retrospective analysis designs.
DiscussionThere is supporting evidence that somatostatin
analogues are beneficial in the treatment of patients with CD. However, more research should be undertaken that include larger sample sizes with surgery-refractory CD to better understand the efficacy of these medications. Likewise, more in-depth research should be done on combination therapy with multiple types of medications for CD in patients who did not undergo surgery to treat
Cushing’s disease. Pasireotide (a somatostatin analogue) was effective in reducing the signs and symptoms of CD, and also resulted in decreasing plasma corticotropin, serum cortisol and urinary free cortisol levels. Therefore, the effectiveness of pairing insulin therapy alongside Pasireotide from the start of treatment should be explored for its effectiveness in decreasing the adverse effects of hyperglycemia.
ConclusionsThe aim of this systematic review was to
investigate and synthesize research completed in the last six years to report the current state of Cushing’s disease treatment using somatostatin analogues. Findings suggest that the medical management of CD with somatostatin analogs is beneficial in patients for whom surgery is not an option or has not been efficacious.
ReferencesColao, A., Petersenn, S., Newell-Price, J., Findling, J.
W., Gu, F., Maldonado, M., Biller, B. M. (2012). A 12-month phase 3 study of pasireotide in cushing's disease. New England Journal of Medicine, 366(10), 914-924. doi:10.1056/nejmoa1105743.
Li, L. Vashisht, K., Boisclair, J., Li, W., Lin, T., Schmid, H.A., Kluwe, W., Schoenfeld, H., & Hoffman, P. (2015). Osilodrostat (LCI699), a potent 11B-hydroxylase inhibitor, administered in combination with the multireceptor-targeted somatostatin analog paseriotide: A 13-week study in rats. Toxicology and Applied Pharmacology, 286, 224-233. doi:10.1016/j.taap.2015.05.004.
Mckeage, K. (2013). Pasireotide: A review of its use in cushing's disease. Drugs, 73(6), 563-574. doi:10.1007/s40265-013-0052-0.
Orrego, J. J., & Barkan, A. L. (2000). Pituitary disorders: Drug treatment options. Drugs, 59(1), 93-106. doi 10.2165/00003495-200059010-00006.
Pas, R., Herder, W., Hofland, L., & Feelders, R. (2013). Recent Developments in Drug Therapy for Cushing's Disease. Drugs, 73(9), 907-918. doi:10.1007/s40265-013-0067-6.
Rajendran, R., Naik, S., Sandeman, D. D., & Nasruddin, A. B. (2013). Pasireotide therapy in a rare and unusual case of plurihormonal pituitary macroadenoma. Endocrinology, Diabetes & Metabolism Case Reports, 130026, doi:10.15.
Web, S.M., et al. (2014). Treatment effectiveness of paseriotide on health-related quality of life in patients with cushing’s disease. European Journal of Endocrinology, 171, 89-98.
Effectiveness of Somatostatin Analogues on Patients Diagnosed with Cushing’s Disease: A Systematic Review of the Current Research
Registration links on the NDNA Facebook page and website at www.ndna.org
NDNA MEMBERS ANNUAL MEETINGSeptember 27th, 2018 from 4-8 pm
Holiday Inn, Bismarck
and our annual Fall Conference
“HEALTHY NURSE, HEALTHY NATION: Creating a Culture of Strength Through
Diversity and Inclusion”
September 28th Heritage Center, Bismarck
SAVE THE DATE
$10,000 Sign-On Bonus for RNs and LPNs!
New Graduates Welcome!
Plus an additional shift differential and weekend premium.
To view current nurse openings and what we have to offer, please visit our website and apply at www.mslcc.com or contact us at:
2425 Hillview AvenueBismarck, ND 58501
(701) 223-9407
Page 4 The North Dakota Nurse August, September, October 2018
Government Affairs, and Tim Casey, Policy Advisor, Polsinelli PC. The morning’s keynote speaker was Representative Paul Tonko (D-NY-20) who shared his passion and commitment to pass legislation that addresses the nation’s opioid crisis. His admiration and respect for nurses were evident, and his inspiring remarks lifted the spirits of every nurse in the room and prepared us for our scheduled meetings.
After the meeting, we were transported by bus from the hotel to Capitol Hill where over 300 nurses from 45 states and the District of Columbia, Guam, and the Virgin Islands attended 277 meetings scheduled with state senators and representatives. In addition, ANA nurse members unable to attend Hill Day in person delivered over 700 messages to senators and representatives via Phone2Action and 5.7 million impressions via Twitter. Upon arrival at Capitol Hill, we joined our colleagues for a group picture, which has become customary for the ANA Hill Day participants.
Our first meeting was with Senator John Hoeven, and his Legislative Correspondent, Ben Bergstrom who is from Devils Lake, ND. The next meeting was with Representative Cramer’s Legislative Assistant, Bree Vculek who is from Oakes, ND. Last we met with Senator Heitkamp and her Health Policy Advisors, Megan DesCamps and Legislative Counsel, Santiago Gonzalez. While attending our meetings with senators, representatives and their staff we had an opportunity to share our state and national priority issues related to nursing and the health and well being of all.
Our first point of discussion centered on H.R 5052 / S. 2446, The Safe Staffing for Nurse and Patient Safety Act which is bipartisan legislation that presents a balanced approach for promotion of development and implementation of valid, reliable, unit-by-unit staffing plans to ensure patient safety. This legislation would require Medicare-participating hospitals to establish a committee, composed of at least 55 percent direct care nurses, to create nurse staffing plans that are specific to each unit. The committee approach recognizes that direct care nurses, working closely with managers, are best equipped to determine the most appropriate staffing levels for their patients. Without optimal registered nurse staffing, patients risk longer hospital stays, increased infections, avoidable medication errors, falls, injuries, and even death.
The Safe Staffing for Nurse and Patient Safety Act protects patients and nurses. Hospitals are feeling pressure to reduce labor costs by eliminating or understaffing registered nurse positions. This leads to lower nurse retention rates and increased readmissions. Increasing the number of registered nurses per patient improves clinical and economic outcomes. This balanced staffing legislation mirrors state models that have been the result of collaborative efforts among state hospital associations, nurse executives, and ANA-affiliated state nurses associations. To date, seven states have enacted safe staffing legislation modeled after the Act’s committee approach including Connecticut, Illinois, Nevada, Ohio, Oregon, Texas, and Washington.
2018 ANA Hill Day and Membership Assembly
2018 Membership Assembly in Review: Experiences While Representing the NDNA
Our next point of discussion was H.R.3692 / S. 2317, The Addiction Treatment Access Improvement Act of 2017, bipartisan legislation introduced by Representative Tonko that presents an opportunity to get more opioid substance use disorder victims into treatment and help them regain control of their lives. The Addiction Treatment Access Improvement Act of 2017 is one of several provisions within H.R. 6, the Substance Use-Disorder Prevention That Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act that includes Medicaid, Medicare, and public health reforms to combat the opioid crisis.
CARA (The Comprehensive Addiction and Recovery Act of 2016) legislation passed in 2016 extended the authority to prescribe MAT to nurse practitioners (NPs) and physician assistants (PAs) through 2021. However, The Addiction Treatment Access Improvement Act of 2017 would build on the successes of CARA by making MAT prescribing authority for NPs and PAs permanent and would expand the ability to prescribe to certified registered nurse anesthetists (CRNAs), clinical nurse specialists (CNSs) and registered nurse midwives (NMs). Advanced Practice Registered Nurses (APRNs) are on the front lines of the opioid crisis and are well-positioned to make a significant impact on many fronts, including expanding access to much-needed medication-assisted treatment (MAT). This prescribing authority is within their respective scopes and would improve access to lifesaving opioid substance use disorder treatment.
A vote on H.R. 6 was slated for the following morning; thus, we had a sense of urgency to relay our message regarding this legislation during our scheduled meetings. As is often the case, there was a looming threat to Representative Tonka’s provision in the form of an amendment. The amendment, referred to as the Dunn Amendment, was introduced by Representative Neal Dunn, R-FL, a member of the GOP Doctors Caucus, and would have eliminated language that allowed APRNs the ability to prescribe MAT. We strongly encouraged our legislators to vote NO on this amendment during our meetings.
The following day, we began the ANA Legislative Assembly meeting with an announcement that the House had passed H.R. 6 with an overwhelming majority, and the Dunn Amendment had been withdrawn from consideration! The meeting room erupted into applause and cheers as we all celebrated the passing of this legislation by the House. Once again nurses had made an impact and were successful in seeing life-saving legislation passed in part, due to our collective efforts. The legislation included 58 individual bills and is expected to be taken up by the Senate as early as mid-July for consideration.
During our meetings, we shared with our legislators that ANA is committed to preventing and reducing gun violence. As the largest single group of health care professionals, nurses are increasingly caring for those victimized by gun violence, and we are forced to confront the physical and emotional consequences of these senseless acts. We strongly urged our legislators to request funding for gun violence research by the Centers for Disease Control and Prevention, aimed at examining the causes and identifying effective prevention strategies.
Senator John Hoeven Senator Heidi Heitkamp
2018 Hill Day continued from page 1
August, September, October 2018 The North Dakota Nurse Page 5
2018 ANA Membership Assembly with President Pam Cipriano 2018 ANA Membership Assembly with Janet Haebler
Our last point of discussion with legislators was to urge them to once again cosponsor H.R. 959 / S.1109 Title VIII Nursing Workforce Reauthorization Act and reauthorize nursing workforce development programs through fiscal year 2022. Current authorization for the programs is through 2020. Title VIII provides the largest source of federal funding for nursing education, and these programs are invaluable to institutions that educate registered nurses for practice in rural and medically underserved communities. For five decades, these programs have helped build the supply and distribution of qualified nurses needed in all health care settings.
The 2018 ANA Membership Assembly officially began Friday morning, June 22nd and business was completed Saturday afternoon, June 23rd. President Pam Cipriano provided the opening remarks at the Assembly to over 300 attendees and noted that advocacy and activism had represented the tone and direction of ANA’s work over the past four years during her two terms as president. President Cipriano highlighted some of the accomplishments during her term including providing leadership during the Ebola crisis, fighting against harmful changes to health care policy after the 2016 election and addressing workplace violence and safe staffing measures. She shared that ANA’s hard work and advocacy had prompted Forbes magazine to call ANA “an increasingly politically powerful lobbying force in Washington, DC and in state capitals across the country.”
ANA’s Honorary Awards were presented to twelve outstanding nurses including Alexandra Wubbels, a Utah Nurses Association member who was awarded the Staff Nurse Patient Advocacy Award for her advocacy of an unconscious patient that resulted in her forcible arrest by police. Another notable award with President Cipriano’s selection of Jimmy Kimmel as the recipient of the President’s Award for Being an Advocate of Improved Health Care for All and Recognizing Life-Saving Work of the Nations Nurses.
Membership Assembly attendees participated in three dialogue forums during the afternoon including:
1) Secondary Opioid Exposure Considerations in Caring for Patients with Overdose;
2) The ANA Presidential Endorsement Process; and 3) The ANA Position Statement Euthanasia, Assisted Suicide, and Aid
in Dying.
During the final day of the 2018 Membership Assembly, eligible Assembly representatives approved and adopted recommendations from the Professional Policy Committee that were developed following the dialogue forums held the previous day. The recommendations call on ANA to:
• Identify informational tools to inform students and nurses about responding to patients who have a potential opioid overdose, and advocate for funding and other support for research and development of evidence-based protocols regarding opioid overdose.
• Refer consideration of the ANA presidential endorsement procedure back to the ANA Board of Directors for development of a revised proposal following further input from ANA members and stakeholders.
• Incorporate the following into a revised position statement on aid in dying: Nurses must respect patients’ right to request aid in dying; nurses must be knowledgeable of the law regarding aid in
dying in the state or territory in which they practice; while nurses are ethically permitted to participate in aid in dying, in states or territories where it is legal, they retain the right to conscientiously object; nurses must be able to provide information on aid in dying and provide emotional support to patients and families who face this decision at the end of life.
Regional meetings held Friday evening provided an opportunity for state representatives to share updates regarding their state associations and accomplishments the past year. Candidates running for election for several open ANA positions who were able to attend the Assembly, joined the regional meetings and shared information about themselves and answered questions from state representatives. The Value-Based Pricing Pilot (VBPP) was discussed and states that had implemented VBPP had their representatives share updates, pros, and cons as well as suggestions for improvements and future considerations.
Friday morning began with elections for open positions for board and committee members. Dr. Loressa Cole, the new ANA Enterprise CEO addressed the Assembly and expressed gratitude for her opportunity in her new role. She noted that “our nation and our patients are counting on us to show up and speak, and we must not fail them.” The day included a Policy Café, with six different topics presented for discussion including occupational licensing policy reform, assistive personnel medication administration, and the opioid crisis.
Election results were shared in the afternoon, and we learned that Ernest Grant, ANA Board Vice-President and member of the North Carolina Nurses Association was elected as ANA’s next president. Dr. Grant is the first man elected to the position of ANA president. As part of the final business of the day, by acclamation, the Membership Assembly endorsed and updated the ANA board statement on the Trump Administration’s practice of separating children from families at the United States border.
We cannot express what an honor and privilege it was for us to represent North Dakota nurses in our Nation’s Capital while meeting with our state’s senators and representative. We were treated with respect by our legislators and their staff who were all hospitable and provided us the opportunity to engage in meaningful and collaborative discussions. As we noted last year, we will once again include our experiences at the 2018 ANA Hill Day to our list of “most memorable nursing opportunities” during our nursing careers.
The 2018 Membership Assembly was another historic event and provided us with an opportunity to join with our nurse colleagues around the nation to conduct the vital business of the Association. We are proud of the work accomplished during the Assembly and are grateful to have had the opportunity to be the voice of North Dakota nurses and to represent NDNA.
Respectfully, Tammy Buchholz, MSN, RN, CNENDNA Membership Assembly Representative
Tessa Johnson, MSN, RNNDNA President
Washington, DC June 21-23, 2018
Page 6 The North Dakota Nurse August, September, October 2018
Appraised by: Brittni Berg, RN &Christina Torgerson, RN
Mayville State University RN-to-BSN students
Clinical question: Does intermittent catherization for patients
with urinary retention reduce the risk of urinary tract infections (UTIs) versus placing an indwelling catheter?
Articles: Kelley, K., Johnson, T., Burgess, J., Timothy, J.N., Weireter,
L., & Jay, N.C. (2017). Effect of implementation of intermittent straight catheter protocol on rate of urinary tract infections in a trauma population. The American Surgeon. 83(7) p.747-749.
Kidd, E.A., Stewart, F., Kassis, N.C., Hom, E., & Omar, M.I. (2015). Urethral (indwelling or intermittent) or suprapubic routes for short-term catheterization in hospitalized adults. Cochrane Database of Systematic Reviews. 12 doi: 10.1002/14651858.CD004203.pub3
Nyman, M.H., Gustafson, M., Langius-Eklof, A., Johansson, J., Norlin, R., & Hagberg, L. (2013). Intermittent versus indwelling urinary catheterization in hip surgery patients: A randomized controlled trial with cost-effectiveness analysis. International Journal of Nursing Studies. 50(12) p. 1589-1598.
Zhang, W., Liu, A., Hu, D., Xue, D., Li, C., Zhang, K., & Pan, Z. (2015). Indwelling versus intermittent urinary catheterization following total joint arthroplasty: A systematic review and meta-analysis. PlosONE, 10(7), 1-13. doi:10.1371/journal.pone.0130636
Synthesis of evidence: This synthesis includes four studies related
to evidence supportive of the proposed research question. The first study was conducted by Kelley, Johnson, Burgess, Timothy, Weireter, and Jay (2017), focuses on trauma patients and reviews infection rates with utilization of indwelling catheters compared to the use of an intermittent catheterization protocol. This is the only study which concluded improvements in catheter associated infection rates with utilization of intermittent urinary catheters.
The second study was conducted by Kidd, Stewart, Kassis, Hom, and Omar (2015), and was a review that analyzed 14 trials with 4,577 participants comparing indwelling catheters with intermittent catheterization. Participants were randomly selected to either get an indwelling catheter or have intermittent catheterization. This Cochrane review concluded that there was insufficient evidence to support one method of catheterization over the other for reducing the risk of urinary tract infections.
Nyman, Gustafson, Langius-Eklof, Johansson, Norlin, and Hagberg (2013), completed the next study, which involved two randomized controlled trials comparing the incidence of urinary tract infections between intermittent catheterization and indwelling catherization for surgical patients. There was a total of 170 participants between the two groups, 18 patients developed UTI symptoms; however, the study concluded that there was no significant difference of urinary infection rates between the two types of catherization.
The last study by Zhang, Liu, Hu, Xue, Li, Zhang, and Pan, (2015), is a meta-analysis comparing the rates of urinary tract infections in patients following joint arthroplasty who are susceptible to post-operative urinary retention. The study involved nine random controlled trials and 1771 participants and again concluded that there was no increase in risk for urinary tract infections when using indwelling catheters versus intermittent catheter use.
Bottom line: Evidence suggests that there is no
significant increased risk for developing
UTIa urinary tract infection when using intermittent catheterization versus indwelling catheterization. Considerations to prevent urinary tract infection in catheter use are length of time the catheter is in place, need for catheter use, and maintaining proper technique when inserting catheters; however, currently there is insufficient evidence to recommend one method of catheterization versus the other when comparing urinary tract infection risks.
Implications for nursing practice: When a patient is experiencing urinary
retention, using a urinary catheter to relieve the bladder of urine is common practice. However, this practice puts patients at an increased risk of acquiring a urinary tract infection. The development of a urinary tract infection can prolong hospital stays, cause pain and discomfort to the patient, and will lead to additional costs to the healthcare organization. Nurses need to be aware of the correlation between catheter use and urinary tract infections to prevent catheter associated infections. It is the nurses due diligence to advocate for their patients utilizing evidence-based indications on whether a catheter is needed and beneficial to their care. Nurses can also support removal of catheters in the recommended time frame and utilize proper technique during catheterization to decrease the risk of urinary tract infections. The role of the nurse is crucial in the implementation of catheter use, care throughout the duration of catheter utilization; the goal being decreased infection rates for patients. The outcome of efficient processes will support patient satisfaction and quality care.
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August, September, October 2018 The North Dakota Nurse Page 7
Appraisal by: Carissa Bucholz, RN; Kelly Stangl, RN; & Paul Koppinger, RN
Mayville State University RN-to-BSN students
Clinical Question:Does the use of bedside reporting versus
traditional nurse to nurse report affect patient satisfaction scores?
Synthesis of EvidenceNursing care has been constantly evolving
since it first began with the lady and the lamp. As time has gone on care has made a circle and now has a goal to be patient centered. One of the current issues faced is, once admitted to an acute facility how are patients involved in their care? A common problem seen in acute and ICU patient care setting is some patients are not even aware of what their admitting diagnosis is (source, year). With a different structure of report now taking place there has been a positive correlation noted between patient satisfaction scores and the use of bedside report (source, year). Nurse to nurse report is being taken out of an enclosed report room and brought back to the most important person involved in care, the patient. Report is now completed at bedside. Patient diagnoses are discussed, current therapies reviewed, and progress evaluated towards the goal of discharge. Bedside report is also utilized to introduce the oncoming nurse, allow the patient to participate in their plan of care and a safety check is typically completed at this time illustrating patient-centered care.
In the article, Interprofessional collaborative care characteristics and the occurrence of bedside interprofessional rounds (2016) 29,173 patients were assessed. 21,493 of them received some form of bedside report. The article goes on to explain that of the 74% of the patients that received this bedside reporting all 74% of those patients stated to have been more satisfied with this process and their care overall (Gonzalo, Himes, McGillen, Shifflet & Lehman, 2016). This study was completed in a large 501-bed university-based acute care hospital. The facility conducting the study were out to achieve >80% compliance to bedside reporting per day on each unit in the hospital to set clear expectations and understanding with the patients. Further evidence shows a positive backing that patient satisfaction scores have increased across the board where bedside report is utilized. In a literary review published in Med Surg Nursing (2013) barriers of bedside reporting reported were; lack of patient privacy that could potentially result in a HIPPA breach, time restraints issues increasing overtime and keeping nursing staff on board. It was found that 90% of nurses encountered one of the above issues (Sherman, Sand-Keclin & Johnson, 2013). Through research these barriers appear to occur in the majority of the studies. In an article published in BMC Medical Services Research (2016) the use of bedside report added patient validity to their care and this was beneficial in the development of patient centered care (O’Hara et al, 2016).
Bedside ReportingBottom Line and Implications for the Nursing Practice
With the implementation of bedside reporting, a more elaborate professional relationship has developed between patient and nurse. With the goal of making care patient centered the patient officially becomes a member of their own care team. Though bedside report has shown promise, further research needs to be completed to better understand what bedside reporting adds to patient care. With further research the current barriers that are being faced by multiple facilities will be a thing of the past.
ReferencesGonzalo, J. D., Himes, J., McGillen, B., Shifflet, V., &
Lehman, E. (2016). Interprofessional collaborative care characteristics and the occurrence of bedside interprofessional rounds: a cross-sectional analysis. BMC Health Services Research, 161-9. doi:10.1186/s12913-016-1714-x
O’Hara, J. K., Lawton, R. J., Armitage, G., Sheard, L., Marsh, C., Cocks, K., . . . Wright, J. (2016). The patient reporting and action for a safe environment (PRASE) intervention: A feasibility study. BMC Health Services Research, 16(1). doi:10.1186/s12913-016-1919-z
Sherman, J., Sand-Jecklin, K., & Johnson, J. (2013). Investigating bedside nursing report: a synthesis of the literature. MEDSURG Nursing, 22(5), 308-318.
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Summer Hayes, Ben Maurer, Taylor Trager, and Maria Zutz; BA Nursing Students, with Dr. Jennifer Bailey DeJong, Faculty Mentor, PhD, FNP-BC,
Associate Professor of Nursing, Concordia College, Moorhead, MN
PurposeThe aim of this systematic review was to investigate and synthesize
research on the current state of Parkinson’s disease (PD) research in the United States.
MethodsA systematic literature review was conducted and the authors equally
divided the studies using both CINAHL and PubMed databases. Eligibility criteria for the population included subjects diagnosed with Parkinson’s disease, and/or the pharmacological or nonpharmacological intervention being assessed was being investigated as a potential treatment for PD. Only English-language articles were included. The database search strategy yielded 13,625 citations. These results were narrowed to 510 studies when the terms were limited to “Parkinson’s disease” and “Nursing.” The results were reduced further with the search criteria of “Parkinson’s disease,” “Nursing,” and “Treatment,” resulting in 99 articles published between 2011 and 2018.
ResultsThe biggest gaps in the literature were the absence of specific
treatments based on differing severities and comorbidities of PD. This is likely due to PD manifestations commonly being inconsistent between individuals. This often makes care of the PD client complex because the multispecialty team must design care from a very individualized approach. In addition, no evidence-based templates for such care models to describe how Parkinson’s treatment should be organized have been developed. The studies assessed that included nursing, were primarily on how to manage PD in the community, used sample sizes of 9 to 400 and used a multi-site, single-blinded, patient-level randomized-controlled trial, and longitudinal designs.
Nursing ImplicationsFindings suggest that a community-based interdisciplinary approach to
treating Parkinson’s disease is most effective, combining physical therapy for postural instability, pharmacotherapies, and community health nurses to ensure compliance to the treatment plan. Dance therapy is also an emerging therapy to treat tremors associated with Parkinson’s. A major theme throughout the articles focused on the development of the specialist nurse role, who could individualize a patient-centered holistic approach to the patient’s PD treatment.
DiscussionGaps in the literature exist. Further research should be conducted on
the physical, medical and surgical interventions in advanced stages of Parkinson’s disease when postural instability is increasingly unresponsive to treatment. In addition, research should continue to branch into known successful treatments and therapies for other chronic conditions and diseases. Although some studies did not directly apply treatments to patients, research did provide evidence of future frameworks and therapies to help better the lives of patients with Parkinson’s disease.
ResourcesCassimatis, C., Liu, K. Y., Fahey, P., & Bissett, M. (2016). The effectiveness of
external sensory cues in improving functional performance in individuals with Parkinson's disease: a systematic review with meta-analysis. International Journal of Rehabilitation Research, 39(3), 211-218. doi:10.1097/MRR.0000000000000171
Connor, K., Cheng, E., Siebens, H. C., Lee, M. L., Mittman, B. S., Ganz, D. A., & Vickrey, B. (2015). Study protocol of "CHAPS": a randomized controlled trial protocol of Care Coordination for Health Promotion and Activities in Parkinson's Disease to improve the quality of care for individuals with Parkinson's disease. BMC Neurology, 15(1), 1-13. doi:10.1186/s12883-015-0506-y
de Natale, E. R., Paulus, K. S., Aiello, E., Sanna, B., Manca, A., Sotgiu, G., & ... Deriu, F. (2017). Dance therapy improves motor and cognitive functions in patients with Parkinson's disease. Neurorehabilitation, 40(1), 141-144. doi:10.3233/NRE-161399
Gibson, G. (2017). What can the treatment of Parkinson's disease learn from dementia care; applying a bio-psycho-social approach to Parkinson's disease. International Journal of Older People Nursing, 12(4), n/a. doi:10.1111/opn.12159
Heisters, D. (2011). Focus on Parkinson's: causes, treatment and support. British Journal of Community Nursing, 16(4), 182-183.
Kim, S., Allen, N., Canning, C., & Fung, V. (2013). Postural Instability in Patients with Parkinson's Disease. CNS Drugs, 27(2), 97-112. doi:10.1007/s40263-012-0012-3
Magennis, B., Lynch, T., & Corry, M. (2014). Current trends in the medical management of Parkinson's disease: implications for nursing practice. British Journal of Neuroscience Nursing, 10(2), 67-74.
Siok Bee, T., Williams, A. F., & Kelly, D. (2014). Effectiveness of multidisciplinary interventions to improve the quality of life for people with Parkinson's disease: A systematic review. International Journal of Nursing Studies, 51(1), 166-174. doi:10.1016/j.ijnurstu.2013.03.009
Van der Marck, M. A., & Bloem, B. R. (2014). How to organize multispecialty care for patients with Parkinson's disease. Parkinsonism & Related Disorders, 20S, 167-73. doi:10.1016/S1353-8020(13)70040-3
A Systematic Review of Parkinson’s Disease Research
in the United StatesAppraised by: Kayla Beauchamp, RN; Shanda Harstad, RN;
Carla Monjaras, RN; Mayville State University RN-to-BSN students
Clinical question:Does bedside reporting affect patients' perception of involvement in their
plan of care?
Articles: Ford, Y., Heyman, A., & Chapman, Y. L. (2014). Patients' perceptions of bedside handoff:
The need for a culture of always. Journal of Nursing Care Quality, 29(4), 371-378. Reinbeck, D. M., & Fitzsimons, V. (2013). Improving the patient experience through
bedside shift report. Nursing Management, 44(2), 16-17. doi:10.1097/01.NUMA.0000426141.68409.00
Rogers, J., Li, R., Clements, R., Casperson, S., & Sifri, C. (2017). Can we talk? The bedside report project.Critical Care Nurse, 37(2), 104-107. doi:10.4037/ccn2017369
Sadule-Rios, N. (2017). Off to a good start: Bedside report. MEDSURG Nursing, 26(5), 343-345.
Tobiano, G., Chaboyer, W., & Mcmurray, A. (2012). Family members’ perceptions of the nursing bedside handover. Journal of Clinical Nursing, 22(1-2), 192-200. doi:10.1111/j.1365-2702.2012.04212.x
Synthesis of evidence:Hospitals encourage bedside reporting to encourage patients be involved in
their plan of care. The nurse must provide change of shift report promoting patient safety and including patients in their plans of care. The literature search for our team’s PICO question was conducted by including key terms: handoff, bedside, report, nursing, patient's perspective, and patient satisfaction. These terms were searched through the EBSCOhost research database and the Cochrane database of systems provided by the Mayville State University library.
After collecting data through observation, field notes, and interviewing in a rehab ward, Tobiano, Chaboyer, and Mcmurray (2012) concluded beside report gives an opportunity for families to be involved in their loved one's care. Families appreciate the opportunity to participate.
Rogers, Li, Clements, Casperson, and Sifri (2017), researched bedside reporting by using a guided platform that was created based on SBAR. The tool was called the 5Ps and includes the patient, background, plan, problem, precautions. Through observation of nursing compliance of bedside reporting and patient's satisfaction reports, medication errors and falls reduced by 80% and 100%, respectively. Patient satisfaction increased 23%, while family satisfaction increased 12% (Rogers et al., 2017).
Sadule-Rios, (2017) studied how patients felt about bedside reporting by reviewing Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores to determine patient satisfaction. Scores improved in all four patient areas on the survey, which include communication, being treated with respect, being listened to, and having things explained in a way they understand. The survey also noted nurses felt better about bedside reporting because they were able to lay eyes on their patients and start safety checks sooner (Sadule-Rios, 2017).
Bottom line:Bedside report influences patients' perception of involvement in their care. By
bringing the report to the bedside, patients are able to hear the plan for their day and participate in their plan of care. As the trend continues to provide patient-centered care, bedside report is an instrumental intervention. Patients can also clear up missing information and help ensure effective communication.
Implications for nursing practice:It is important to adapt this nursing practice in healthcare settings.
Bedside reporting promotes patient safety and autonomy. Ford, Heyman, & Chapman, (2014) suggested a culture of bedside reporting by conducting a "flash mob" (unannounced observation of compliance) and sharing positive highlights in huddles or meetings. Reinbeck and Fitzsimons (2013) state "bedside report has been shown to empower staff, improve patient involvement, and allow for a safe transition of care between providers. It establishes and promotes trusting relationships between patients and staff members, which serve as a foundation for teamwork" (p. 17).
Does Bedside Reporting Affect Patients Perception of
Involvement in Their Plan Care?
August, September, October 2018 The North Dakota Nurse Page 9
Appraised by: Crystal Graening, RN; Breanna Hanan, RN; & Kathyrn Kapocius, RN Mayville State University RN-to-BSN students
Clinical question: When caring for an elderly patient in the
hospital, how do hourly rounds affect the incidence of falls on the unit compared to a unit that doesn't utilize hourly rounding?
Articles: ECRI Institute. (2016) Falls. Retrieved from https://
www.ecri.org/components/HRC/Pages/SafSec2.aspx?tab=2#
Goldsack, J., Bergey, M., Mascioli, S., & Cunningham, J. (2015). Hourly rounding and patient falls: What factors boost success? Nursing, 45(2), 25-30. doi: 10.1097/01.NURSE.0000459798.79840.95
Hicks, D. (2015). Can Rounding Reduce Patient Falls in Acute Care? An Integrative Literature Review. MEDSURG Nursing, 24(1), 51-55. Retrieved from https://odinproxy04.odin.nodak.edu:2162/ehost/pdfviewer/pdfviewer?vid=1&sid=c98a339e-04c7-4ca1- 9a00-3345fe4ae322%40sessionmgr120
Weisgram, B., & Raymond, S. (2008). Using Evidence-Based Nursing Rounds to Improve Patient Outcomes. MEDSURG Nursing, 17(6), 429-430. Retrieved from https://odinproxy04.o d i n . n o d a k . e d u : 2 1 6 4 / e h o s t / p d f v i e w e r /pdfviewer?vid=1&sid=b268903f-f532-4a20-acb9-4b1de6657545%40sessionmgr4008
Synthesis of evidence: As nurses, we are aware of the huge problems
that falls can cause. Within hospitals, falls are one of the top reported adverse events occurring every year (Hicks, 2015). Fall rates range from 1.3 to 8.9 falls per 1000 inpatient days spent in acute care, 30% of which are estimated to result in serious injury to the patient (Goldsack, Bergey, Mascioli, & Cunningham, 2015). Through research, we attempted to determine if there is any relation between the practice of hourly rounding by nursing staff within hospitals and reducing the number of falls that occur during hospitalizations.
In looking through research as to what has helped hospitals deter and prevent falls, we focused on whether the implementation of hourly rounding by nursing staff decreased the number of falls occurring within inpatient acute care settings. We used EBSCOHOST research databases as well as the Cochrane database. We focused on articles that had been published within the past 10 years and within a peer-reviewed journal. If the article discussed hourly rounding and fall prevention outside the acute care setting, it was dismissed, as our focus was on the inpatient setting.
The studies used various methods to research whether or not there is any correlation between hourly rounding and fall prevention. Two of the studies focused on the actual process of hourly rounding, using various ways to look
at and measure the impact of hourly rounding on different units within different hospitals. The studies also used multiple methods of implementing hourly rounding to try to determine what works best for units and what helps nursing staff be more receptive of the process. In the first study, when nursing leadership and support by front line staff for hourly rounding was present on a particular unit, falls dramatically decreased after the implementation of hourly rounding (Goldsack et al., 2015). However, in the same study on a different unit that did not have this support and simply implemented hourly rounding without any guidelines, no significant impact was seen (Goldsack et al., 2015).
Another study looked at 14 articles using an integrative review method to help provide research to whether hourly rounding is beneficial to preventing falls in hospitalized patients (Hicks, 2015). While most studies highlighted showed a positive effect on fall rates during the implementation of hourly rounding, limitations of the studies were also identified, such as nonrandomized samples, small sample sizes, and the time given to collect data for the studies. Because of this, most of the studies were unable to show whether hourly rounding and the positive effect it had on fall prevention could be sustained long term.
Two other articles focused on investigating what was causing falls. From there, further effort was made to implement hourly rounding with specific guidelines and steps to determine if hourly rounding could impact fall rates based on what was causing them. These studies were again limited by sample sizes and time; however, both highlighted the significant impact hourly rounding can have on fall prevention if it is consistent and has the support of leadership and staff.
Bottom line: Studies thus far have identified that with
strong support by nursing staff and nurse leaders, hourly rounding can lead to fewer falls. While initial research shows positive impacts on decreasing falls in the hospital through hourly rounding, research has failed to fully address the impact both due to limited longevity and patient uniqueness. Because of this, research is inconclusive on whether hourly rounding affects the incidence of falls on units within hospitals compared to units that do not utilize it. Further research and better methods to implement hourly rounding need to occur to more fully explore the impact of hourly rounding on falls within the inpatient setting.
Implications for nursing practice: Patient falls have been an important topic in
nursing as falls have been shown to cause severe patient injuries, lengthen days of hospital stay, and increase healthcare costs (ECRI, 2016). Falls are also happening more and more. Nurses must be diligent about fall prevention interventions to provide the best care possible and decrease those statistics. There is promising research that shows hourly rounding that is purposeful and carried out each and every shift by all nursing staff can decrease the number of falls that occur during hospitalizations. Nurses need to be aware of and educate themselves on the positive effects hourly rounding can have and work to include hourly rounds daily. Nurses should also be advocators of having hourly rounding implemented on their units with support from nursing leadership so that it is accepted and practiced to the point that it makes a positive impact on decreasing falls.
Hourly Rounding Falls
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Emily Goff, Emily Hughes, Emma Mitzel, and Brandon Quibell; BA Nursing Students, with Dr. Jennifer Bailey DeJong, Faculty Mentor,
PhD, FNP-BC, Associate Professor of Nursing, Concordia College, Moorhead, MN
IntroductionALS, or amyotrophic lateral sclerosis, is a
progressive neurodegenerative disease that affects nerve cells in the brain and spinal cord. In ALS, motor neurons degenerate and lose their ability to function. With the loss of muscle movement, those diagnosed with ALS can lose their ability to speak, eat, move and breathe. Symptoms vary from person to person. Though the rate of degeneration varies, progressive muscle weakness and paralysis are universally experienced. Diagnosis of ALS is difficult and is usually found by ruling out other diseases that mimic ALS. Since discovering the disease in 1869, there have been many strides. In the recent years, researchers have intensely studied the physiology of ALS. Unfortunately, the FDA has only approved one drug for the treatment of ALS – Riluzole. Though this drug does not cure ALS, it does slow the progression of the disease. While there are many studies on ALS, outcomes to date have not significantly altered providers’ approach to treatment (ALS Association, 2018). The aim of this systematic review was to investigate and synthesize research on the current state of ALS treatment.
MethodA literature search of PubMed using the terms
“ALS and treatment” within the last five years in full-text and English retrieved 2,122 results. The same search criteria was used on CINAHL which resulted in a total of 35 articles.
A team of four members each spent one and a half hours searching for articles using the above search terms, resulting in a total of six hours of extensive literature search. From each search, the number of articles published exclusively in the year 2013 were recorded. This process of analysis continued year by year until the team finalized its review in present day (March 2018). In addition to the number of articles found within each year, key terms were recorded in order to
understand what the predominant themes were in each article.
ResultsUsing the terms “ALS and treatment”, the
numbers of articles retrieved from the two databases varied widely between 2013 and 2017.
PubMed CINAHL
2013- 324 (15%) 6 (17%)
2014- 397 (19%) 4 (11%)
2015- 435 (20.5) 9 (26%)
2016- 446 (21%) 13 (37%)
2017- 467 (22%) 3 (9%)
2018- 53 (2.5%) 0 (0%)
Because of the large numbers of articles and wide variability of the themes, the team decided to narrow its search further by only examining articles published in 2018. This resulted in 53 articles from PubMed and zero from CINAHL.
After locating articles, the team identified the purpose of each article and separated them into one of five overarching categories: a) genetic-focused treatment, b) drug treatment, c) nutrition, d) alternative treatments, and e) other. Genetic-focused treatments were the theme in 40% of the articles (21 of 53) and included research on the C9OR72 gene, RNA G-quadruplexes, SCAAV9-h1GF1, TDP-43, and SOD1. Articles discussing drug therapies made up 30% (16 of 53). Some of the main drugs highlighted included Riluzole, anti-inflammatory drugs, and immunosuppressants. Nutrition articles constituted only three of the 53 articles (0.05%) and were related to iron and creatinine therapies. Of the 53 articles, eight (15%) highlighted alternative treatment therapies, including spinal therapies, decreasing fatigue, and the use of assistive technology devices. The “other treatments” category comprised nine percent (5 of 53), and primarily discussed access to care.
DiscussionBased on a systematic review of literature in
2018, using PubMed and CINAHL, there is a
The State of ALS Treatment:A Systematic Review of Current Research
need for further investigation of how nutrition or alternative approaches in the treatment of ALS impacts outcomes. Another area that needs more investigation using an experimental design is the effects of ALS treatment on actual patients. Researchers note that the effects of ALS treatment are not clearly identified because there is lack of supporting evidence for patient outcomes.
A potential limitation of the systematic review is that only two databases were analyzed. The team only focused on studies from 2018 (encompassing 2½ months of study); therefore, the research is not reflective of all research on ALS that is “current.” If the team had narrowed the search using the terms “nutrition” and “ALS,” results over the last few years may indicate no gap at all. In short, research articles from 2018 may not mirror the types of studies completed recently.
ConclusionsThe aim of this systematic review was to
investigate and synthesize the current state of ALS research. While the team found numerous articles on ALS, the treatment themes were broad. No one specific treatment approach was identified as beneficial to all patients with ALS. Further research needs to be conducted. Gene therapy and drug therapy are trending in 2018 and will continue to evolve. Finally, application of findings from research studies to actual patients with ALS is necessary to fully understand the effectiveness of treatment.
ReferencesAmyotrophic Lateral Sclerosis (ALS) Fact Sheet. (n.d.).
Retrieved February 22, 2018Dorst, J., Ludolph, A. C., Huebers A., (2018).
“Disease-modifying and symptomatic treatment of amyotrophic lateral sclerosis.” doi: 10.1177/1756285617734734
Herrmann, D., Parlato, R. (2018). “C9orf72-associated neurodegeneration in ALS-FTD: breaking new ground in ribosomal RNA and nucleolar dysfunction.” Cell Tissue Res. doi: 10.1007/s00441-018-2806-1.
Oh, J., Oh S.I., Kim, J.A, (2018). “The amyotrophic lateral sclerosis supportive careneeds assessment instrument: Development and psychometric evaluation.” Palliative Support Care. doi: 10.1017/S1478951517001250
Mathis, S., Le Masson, G. (2018). “RNA-Targeted Therapies and Amyotrophic Lateral Sclerosis.” Biomedicines. 6(1). doi: 10.3390/biomedicines6010009.
“What is ALS?” (n.d.). Retrieved February 22, 2018, http://www.alsa.org/about-als/what-is-als.html
August, September, October 2018 The North Dakota Nurse Page 11
Abbey Domyahn, Sadie Ness, Sofia Olesen, Brianna Poppenga, Elizabeth Viergutz; BA Nursing Students, with Dr. Jennifer Bailey DeJong,
Faculty Mentor, PhD, FNP-BC, Associate Professor of Nursing, Concordia College, Moorhead, MN
IntroductionThe aim of this systematic review was to investigate and synthesize
the current evidence on the effects of exercise on patients diagnosed with Multiple Sclerosis (MS).
MethodA literature search was completed using the Cumulative Index to
Nursing & Allied Health Literature (CINAHL) database. The database strategy yielded 1,580 citations. These results were narrowed to 105 studies based on the inclusion criteria by adding “exercise” to search results. Results were narrowed further to 50 studies by adding “gait” to the search criteria. Team members equally divided the articles for analysis.
ResultsSearch results indicate that extensive research has been done in the last
five years on this topic. The studies commonly focused on the benefits and disadvantages of different forms of physical activity in patients with mild and moderate cases of multiple sclerosis. Sample sizes ranged from nine to 50 participants. A combination of qualitative and quantitative research methods were employed. The majority of the studies were conducted in the United States, Australia, Norway, and Canada.
DiscussionThere is supporting evidence that a variety of exercises for those with
MS reduces levels of fatigue and depression while also improving quality of life and mobility. Exercise was also shown to enhance the mental health of patients diagnosed with MS. In multiple articles, the effectiveness of behavioral change strategies, such as motivational interviewing, in relation to exercise and MS were studied.
Yet, gaps in the literature exist. Many of the studies only included patients diagnosed with mild to moderate stages of MS and didn’t include patients with severe disability. Researchers also reported difficulty in measuring levels of client fatigue. Other concerns included: the use of vague descriptions of the exercises employed, and the use of varying tools when measuring levels of disability.
ConclusionsThe aim of this systematic review was to investigate and synthesize
research completed in the last five years to report the current state of exercise recommendations for patients diagnosed with MS. Findings suggest exercise for those with MS reduces levels of fatigue and depression while also improving quality of life and mobility. Further research should be conducted on the effects of exercise on MS. Likewise, the effects of exercise on self-esteem and body image in patients with MS should be considered. In addition, research should focus on the short- and long-term effects of exercise programs and the levels of exercise required to benefit patients of varying levels of disability.
ReferencesBrændvik, S. M., Koret, T., Helbostad, J. L., Lorås, H., Bråthen, G., Hovdal,
H. O., ...et al. (2016). Treadmill training or progressive strength training to improve walking in people with multiple sclerosis? A randomized parallel group trial. Physiotherapy Research International, 21(4), 228-236. doi:10.1002/pri.1636
Doring, A., Pfueller,C. F., Friedemann, P., & Dörr, P. (2012). Exercise in multiple sclerosis–an integral component of disease management. Springer EMPA Journal 3(1), 2. doi.org/10.1007/s13167-011-0136-4
Galea, M. P., Lizama, L. C., Butzkueven, H., & Kilpatrick, T. J. (2017). Gait and balance deterioration over a 12-month period in multiple sclerosis patients with EDSS scores ≤ 3.0. Neurorehabilitation, 40(2), 277-284. doi:10.3233/NRE-161413
Jolk, C., Dalgas, U., Osada, N., Platen, P., & Marziniak, M. (2015). Effects of sports climbing on muscle performance and balance for patients with multiple sclerosis: A case series. International Journal of Therapy & Rehabilitation, 22(8), 371-376. Retrieved from http://web.b.ebscohost.com/ehost/detail/detail?vid=26&sid=56a8d173-1383-422c-b406-305f6889de90%40sessionmgr104&bdata=JnNpdGU9ZWhvc3QtbGl2ZSZzY29wZT1zaXRl#AN=109826392&db=rzh
Krüger, T., Behrens, J. R., Grobelny, A., Otte, K., Mansow Model, S., Kayser, B., ...et al. Schmitz-Hübsch, T. (2017). Subjective and objective assessment of physical activity in multiple sclerosis and their relation to health-related quality of life. BMC Neurology, 17(1-12). doi:10.1186/s12883-016-0783-0
Larson, R. D., McCully, K. K., Larson, D. J., Pryor, W. M., & White, L. J. (2014). Lower-limb performance disparities: Implications for exercise prescription in multiple sclerosis. Journal of Rehabilitation Research & Development, 51(10), 1537-1543. doi:10.1682/JRRD.2013.09.0191
Learmonth, Y. C., Adamson, B. C., Balto, J. M., Chiu, C., Molina-Guzman, I., Finlayson, M., ... et al.(2017). Multiple sclerosis patients need and want information on exercise promotion from healthcare providers: a qualitative study. Health Expectations, 20(4), 574-583. doi:10.1111/hex.12482
Padgett, P. K., & Kasser, S. L. (2013). Exercise for managing the symptoms of multiple sclerosis. Physical Therapy, 93(6), 723-728. doi:10.2522/ptj.20120178
Smith, C. M., Hale, L. A., Olson, K., Baxter, G. D., & Schneiders, A. G. (2013). Healthcare provider beliefs about exercise and fatigue in people with multiple sclerosis. Journal Of Rehabilitation Research & Development, 50(5), 733-743. doi:10.1682/JRRD.2012.01.0012
Smith, D. C., Lanesskog, D., Cleeland, L., Motl, R., Weikert, M., & Dlugonski, D. (2012). Motivational interviewing may improve exercise experience for people with multiple sclerosis: A small randomized trial. Health & Social Work, 37(2), 99-109. doi:hsw/hls011
Swank, C., Thompson, M., & Medley, A. (2013). Aerobic exercise in people with multiple sclerosis: Its feasibility and secondary benefits. International Journal of MS Care, 15(3), 138–145. http://doi.org/10.7224/1537-2073.2012-037
Effects of Exercise on Patients Diagnosed with Multiple Sclerosis:
A Systematic Review of the Current Research
Page 12 The North Dakota Nurse August, September, October 2018
Jordan Martins, Max Nelson, Erik Sneltjes, and Becca Trunk; BA Nursing Students, with Dr. Jennifer Bailey DeJong, Faculty Mentor,
PhD, FNP-BC, Associate Professor of Nursing, Concordia College, Moorhead, MN
IntroThe aim of this systematic review is to
investigate and synthesize research on the current state of the drug Dinutuximab when used to treat pediatric neuroblastoma. The following research was synthesized in the last five years to report the current state of the science related to Dinutuximab treatment for pediatric neuroblastoma.
MethodsEligibility Criteria The inclusion criteria were Dinutuximab
treatment that included children ages 18 months to under the age of 21 with sufficient organ function in the sample population and original national research. The search was limited to English-language articles from January 2013 to October 2017.
SearchA literature search was completed with the
assistance of a professional academic librarian in two databases: PubMed (MEDLINE) and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Keywords used to retrieve sources were ‘neuroblastoma,’ ‘pediatric,’ and ‘treatment Dinutuximab,’ providing the search strategies for both databases.
Study SelectionThe database search strategy for CINAHL
yielded 476 citations. These results were narrowed down to seven studies based on inclusion criteria. The same search strategy was applied in PubMed and yielded 3,713 citations. After adding the key terms once again for inclusion criteria, 31 studies were obtained. After further inspection of the studies, seven more were chosen for further evaluation and synthesis. An illustration of the study selection is presented in the figure below. References of the final 14 articles found were reviewed for additional articles. No additional articles were added. All 14 of the articles’ studies reviewed were conducted in the United States.
Data Collection ProcessA data extraction form was created for the 14
identified research articles. The authors equally divided the studies and individually extracted the following data: design, purpose, sample, intervention, control, measurements, outcomes, limitations, and notes. The data was then checked by all four authors and a consensus was reached. A summary narrative was conducted.
ResultsThe biggest gap in the literature was an
inconsistency of studies available. Each study had a different focus about Dinutuximab therapy such as side effects and nursing care, maintainance therapy, side effects, mechanism of action of the drug, and how the drug was developed. There were few studies on each specific topic.
DesignsSix studies used a quantitative design, with
three using experimental design, one quasi experimental design, one correlational design, and one randomized-experimental design. Eight studies used a qualitative design, including six literature reviews, one being a review of multiple correlational and experimental studies, one being a review of quantitative studies, and two literature reviews. Two case studies were included in the qualitative design research articles.
Sample & SettingAll of the quantitative studies had sample
sizes ranging from 28 - 289 patients, with the median of 226. There were two sample sizes in the qualitative studies, both were the case studies found, including one 3 year old and one 5 year old child.
A variety of professions and settings were represented in the studies. Pediatric patients with neuroblastoma receiving Dinutuximab treatment was deemed the priority inclusion criteria (n = 14). There were multiple disciplines who performed the research with the pediatric patients or laboratory mice. Seven studies included medical doctors. Seven studies included professional researchers. Four studies included registered nurses. Three studies included pharmacists. Two studies included advanced practice nurses. Four different studies included one of the following professions; transfusionist, nursing student, pathologist, and a laboratory technician.
Nine studies were conducted in the practice setting, on a pediatric oncology unit. Three studies were located outside of the practice setting for literature review. Two studies were in a research setting, testing mice.
Interventions The interventions included the treatment of
either maintenance or induction therapy, using the drug Dinutuximab (dosing ranging from 80-160 mg/m2), for the pediatric neuroblastoma population, adults with low-burden tumor follicular lymphoma, or mice that were injected with the neuroblastoma cancer cells.
Measurement InstrumentThe quantitative studies used the EFS
(five year survival rate) to measure if the interventions were successful or had no therapeutic effect. The goal of the treatment was to remain free of signs of tumor development or decrease the growth of neuroblastoma tumors in the pediatric population. Another instrument used in qualitative designs was observation, which then documented the patient's outcomes during and after treatment with Dinutuximab.
OutcomesStudy outcomes were generally positive, but
negative outcomes were reported in a number of studies. Dinutuximab’s effectiveness primarily targeted a specific genotype (KIR3DL1+/HLA-Bw4+) when outcomes were positive. Three studies focused more on the side effects and management of the complicated treatment regimen of Dinutuximab, rather than the outcomes.
DiscussionOnly five studies implemented an experimental
research design and only one study implemented a randomized design. This may be a direct result as to why the focus of the research gathered is scattered. The search yielded information about maintenance therapy, side effects, nursing implications, mechanism of action, development of the drug, and five year survival rates (ESF) of patients using the medication. Although there were commonalities throughout the articles, the largest was that Dinutuximab is an effective drug during maintenance therapy of neuroblastoma treatment. In all five qualitative studies, the ESF increased when the patients added Dinutuximab to the therapy. Patients were generally healthy during the treatment regimen, therefore there were no delays in receiving Dinutuximab, which increased the efficacy of the medication. Furthermore, the size of the tumors did not increase in size or began to reduce in size when the medication was added to treatment. Decreasing tumor sizes or allowing the size to remain stagnant increases the chance for the child to continue in remission with possible cure. In addition, nursing considerations such as understanding typical side effects of the medication were prominent in many literature reviews. Nurses should be aware that pain and fever are the two most common side effects, therefore a patient should be administered acetaminophen or morphine prior to induction of the medication if they have had the side effects in the past. Other common side effects are changes in blood pressure, complete blood count (CBC), or electrolytes, which are monitored and treated daily, and anaphylaxis which occurs in less than two percent of all patients. Following standards of care, the side effects should be caught before irreversible damage occurs to the patient.
Still gaps in the literature remain; an area needing investigation is using the experimental design in the treatment regimen of Dinutuximab on low risk vs standard risk vs high risk pediatric neuroblastoma to see if the effects/outcomes of the treatment differ based on the severity of the cancer. Another area of research to further examine would be the effects of Dinutuximab on pediatric neuroblastoma patients in remission and compare that to the effects of the drug during induction therapy, so the medication regimen can be more regulated. Furthermore, the validated instruments in the review of research evaluated survival rates, therapeutic effects, and side effects of treatment, which coincide in both the qualitative and quantitative research. Both data types are important to assess, whether experimental or observational, however, since clinical practice using the drug was the primary interest, more experimental studies could be done to close the gaps in the literature.
In terms of the quality of studies evaluated in this research, there is a need to increase the rigor of the research. Approximately 14% of the quantitative research studies did not use a validated measurement instrument, leaving the findings questionable. The lack of research that focuses on the survival rate, varying range
Use of Dinutuximab in Pediatric Neuroblastoma Treatment: A Systematic Review of the Current Research
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August, September, October 2018 The North Dakota Nurse Page 13
in sample sizing, and same diagnoses when including which risk type of neuroblastoma the pediatric patients had do not allow the readers to determine the exact outcome of the treatment Dinutuximab. Future studies should include the exact diagnosis, including the risk type, and which stage of treatment (induction, consolidation, maintenance, remission) that Dinutuximab is being used for.
ConclusionsThe aim of this systematic review was to
investigate and synthesize research completed in the last five years to report the current state of pediatric neuroblastoma treatment, specifically Dinutuximab therapy. Findings suggest that when the Dinutuximab treatment is used in patients with the preferred genotype, the result is typically more positive. These findings represent a revolutionary treatment that can extend the life or cure a patient diagnosed with pediatric neuroblastoma.
References1. Anghelescu, D. L., Goldberg, J. L., Funghnan, L.
G., WU, J., Mao, S., Furman, W. L., . . . Navid, F. (n.d.). Comparison of Pain Outcomes between Two Anti-GD2 Antibodies in Patients with Neuroblastoma. Pediatric Blood Cancer, 62(2), 224-228. doi:10.1002/pbc.25280
2. Bartholomew, J., Washington, T., Bergeron, S., Nielson, D., Saggio, J., & Quirk, L. (2017). Dinutuximab: A Novel Immunotherapy in the Treatment of Pediatric Patients With High-Risk Neuroblastoma. Retrieved February 14, 2018, from http://journals.sagepub.com/doi/pdf/10.1177/1043454216659448
3. Dhillon, S. (2015). Dinutuximab: First Global Approval. Drugs, 75(1), 923-927.
4. Erbe, A. K., Wang, W., Reville, P. K., Carmichael, L., Kim, K., Mendonca, E. A., . . . Sondel, P. M. (2017, June 12). HLA-Bw4-I-80 Isoform Differentially Influences Clinical Outcome As Compared to HLA-Bw4-T-80 and HLA-A-Bw4 Isoforms in Rituximab or Dinutuximab-Based Cancer Immunotherapy. Retrieved February 21, 2018, from https://www.ncbi.nlm.nih.gov/pubmed/28659916
5. J. B., Washington, T., Bergeron, S., Nielson, D., Saggio, J., & Quirk, L. (2017). Dinutuximab: A Novel
6. Immunotherapy in the Treatment of Pediatric Patients With High-Risk Neuroblastoma.
7. Pediatric Oncology Nursing, 34(1), 5-12. Retrieved January 08, 2018
8. Marachelian, A., Desai, A., Balis, F., Katzenstein, H., Qayed, M., Armstrong, M., . . . Smith, M. L. (2016). Comparative pharmacokinetics, safety, and tolerability of two sources of ch14.18 in pediatric patients with high-risk neuroblastoma following myeloablative therapy. Cancer Chemother Pharmacol, 77, 405-412. doi:10.1007/s00280-015-2955-9
9. McGinty, L., Kolesar, J., (2017). Dinutuximab for maintenance therapy in pediatric neuroblastoma. American Society of Health-System Pharmacists, 74(8), 563- 567. doi10.2146/ajhp160228
10. Plossel, C., Pan, A., Maples, K. T., & Lowe, D. K., (2016). Dinutuximab: An anti-GD2 monoclonal antibody for high-risk neuroblastoma. Annals of Pharacotherapy, 50(5), 416-422. doi 10.1177/1060028016632013
11. Secola, R., Marachelian, A., Cohn, S. L., Toy, B., Neville, K., Granger, M., . . . Martin, G. (2017, January 6). The Role of Nursing Professionals in the Management of Patients With High-Risk Neuroblastoma Receiving Dinutuximab Therapy. Retrieved February 5, 2018, from http://journals.sagepub.com/doi/pdf/10.1177/1043454216680595
12. Tran, H. C., Wan, Z., Shear, M. A., Sun, J., Jackson, J. R., Malvar, J., … Seeger, R. C. (2017) TGFBR1 blockade with galunisertib enhances anti-neuroblastoma activity of the anti-GD2 antibody Dinutuximab with natural killer cells. Clinical Cancer Research, 23(3), 804-813. doi10.1158/1078-0432.CCR-16-1743
13. Whittle, Sarah B. (2017). Overview and recent advances in the treatment of neuroblastoma. Expert Review of Anticancer Therapy, 17(4), 369-386.
14. Zenarruzabeitia, O., Vitallé, J., Astigarraga, I., & Borrego, F., (2016). Natural killer cells to the attack: Combination therapy against neuroblastoma. Clinical Cancer Research, 23(3), 615-617. doi 10.1158/1078-0432.CCR-16-2478
15. Zulmarie Perez Horta, J. L. (2016). Anti-GD2 mAbs and next-generation mAb-based agents for cancer therapy. Immunotherapy, 8(9), 1097–1117.
Appraised by: Courtney Amb, RN; Helen Schuster RN; & DeeAnna Wynalda (Schmakel) RN
Mayville State University RN-to-BSN student
Clinical question: Are elementary aged children, who are
considered obese, at an increased risk for obesity as an adult compared to children who are not obese?
Articles:Li, S., Chen, W., Sun, D., Fernandez, C., Li, J., Kelly,
T., He, J., Krousel-Wood, M., & Whelton, P. (2015). Variability and rapid increase in body mass index during childhood are associated with adult obesity. International Journal of Epidemiology. 1943-1950. doi:10.1093/ije/dyv202.
Mead E, Brown T, Rees K, Azevedo LB, Whittaker V, Jones D, Olajide J, Mainardi GM, Corpeleijn E, O'Malley C, Beardsmore E, Al-Khudairy L, Baur L, Metzendorf MI, Demaio A, Ells LJ. Diet, physical activity and behavioral interventions for the treatment of overweight or obese children from the age of 6 to 11 years. Cochrane Database of Systematic Reviews, 2017, Issue 6. Art. No.: CD012651. DOI: 10.1002/14651858.CD012651
Moore, E. S., Wilke, W. L., & Desrochers, D. M. (2017). All in the family? Parental roles in the epidemic of childhood obesity. Journal of Consumer Research, 43(5), 824- 859. doi:10.1093/jcr/ucw059
Shah, D., & Maiya, A. (2017). Prevalence of childhood obesity in Anand District. Indian Journal of Physiotherapy & Occupational Therapy, 11(3), 21-26. doi:10.5958/0973-5674.2017.00066.
Synthesis of evidence: Our team has researched 12 different articles
on how obesity in children affects adulthood obesity. These studies go into detail on the affect obesity can have throughout a child’s life. These studies provide evidence that there is a need for intervention early in childhood to help prevent this worldwide epidemic. These studies provide information that family is a key component in helping prevent obesity.
The first article in our reference list studies how obesity is a major public health challenge due to its high prevalence, its importance as a major risk factor for many chronic diseases and the magnitude of its association with mortality. The challenge of successfully reversing obesity once established and maintaining weight loss over the long term is well known. Prevention of obesity would have a significant impact in addressing our current worldwide obesity epidemic and the associated growing chronic disease burden. To achieve this goal, it is important to identify risk factors in early life for obesity (Li, et al. 2015).
Mean BMI during childhood was the strongest predictor of adult obesity measures, consistent with previous observations. Importantly, there was an independent association between rate of change in BMI during childhood with adult obesity measures, which extends previous observations that rapid growth during infancy is a risk factor for adult obesity. Taken together, available evidence suggests that rapid increase in BMI in the first two decades of life is a potent risk factor for adult obesity (Li, et al. 2015).
The second article reviews different interventions that children can do to overcome childhood obesity in children ages 6 to 11. One main intervention is to limit energy intake and increase energy expenditure. This article goes through the different comorbidities that can go along with obesity and also ways to battle childhood obesity for parents. This study shows that diet and exercise can have a small change on body mass index for short time periods, but obesity is a relapsing condition without continued interventions. One limitation in this study that
it only covers six months follow up, and further research can be done with follow ups after six months (Mead, et al., 2017).
This third article by Moore, et al. (2017), describes the potential factors for childhood obesity. It goes over the different factors and framework for obesity. Childhood obesity is a huge problem within the United States. This study shows why it is so prevalent in the United States. This study goes into great detail of how the family network has a huge role in childhood obesity. This study has shown the importance of having equal diet and exercise within childhood. The framework for childhood obesity comes from the family with diet, exercise, genetics, and family health knowledge. Parents need to have good knowledge on healthy diets and exercises for children (Moore, et al., 2017).
In the final study, overweight and obese children were seen in 23.8% in urban schools and 14.2% in rural schools. A study also reported obesity to be 4.5% in low income schools and 22% in mid-income schools. The study also showed prevalence of overweight higher than obesity, 14.5% in boys, 12.8% in girls, and obesity being 6.3% in both boys and girls. In conclusion, this study found a higher frequency of overweight and obesity in urban areas and boys as compared to girls and children from rural areas (Shah & Maiya, 2017).
Bottom line: In conclusion, all of these studies have shown
that there is significant evidence that obesity as a child is a risk factor for obesity in adulthood. This is a worldwide public health concern and there are a number of interventions that can be done to help decrease the risk of obesity. Risk factors need to be identified and interventions implemented to help decrease obesity. The key to these interventions is to start them early, start in childhood and inform families of benefits of these interventions. The framework for childhood obesity comes from the family with diet, exercise, genetics, and family health knowledge (Moore, et al., 2017.)
Implications for nursing practice:Evidence-based education is really needed
when it comes to obesity. Nurses can provide education regarding proper diets for children and use MyPlate examples illustrating portion sizes on each food group. Exercise plans are also important. Children should be in activities that are age appropriate. Screen time is another very important area to provide education. Nurses should also give out general information so that parents can understand weight regulation and the obesity development from childhood to adulthood.
Obesity in Children
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Appraised by: Kelsey Schlenk, RN & Christina Waddle, RN
Mayville State University RN-to-BSN students
Clinical question: For hospitalized patients, can focused nursing
assessments affect the occurrence of catheter-associated urinary tract infections (CAUTI) in comparison to routine nursing assessments?
Articles: Dy, Sitha, Major-Joyness, B., Pegues, D., & Bradway,
C. (2016). A nurse-driven protocol for removal of indwelling urinary catheters across a multi-hospital academic healthcare system. Urologic Nursing, 36(5), 243-249. doi: 10.7257/1053-816X.2016.36.5.243
Giles, M., Watts, W., O’Brien, A., Berenger, S., Paul, M., McNeil, K., & Bantawa, K. (2015). Does our bundle stack up! Innovative nurse-led changes for preventing catheter-associated urinary tract infection (CAUTI). Healthcare Infection, 20, 62-71.
Lam, T.B., Omar, M.I., Fisher, E., Gillies, K. & MacLennan, S. (2014). Types of indwelling urethral catheters for short-term catheterization in hospitalized adults. Cochrane Database of Systematic Reviews, 9, 1-95. doi:10.1002/14651858.cd004013.pub4
Thomas, K. L. (2016). Reduction of catheter-associated urinary tract infections through the use of an evidence-based nursing algorithm and the implementation of shift nursing rounds. Journal of Wound, Ostomy & Continence Nursing, 43(2), 183-187. doi:10.1097/WON.0000000000000206
Underwood, Lindsay. (2015). The effect of implementing a comprehensive unit-based safety program on urinary catheter use. Urologic Nursing, 35(6), 271-278. doi: 10.7257/1053
Synthesis of evidence: We analyzed a total of eight articles that were
narrowed down to five for our research. In the article addressed by Thomas (2016), a project was completed in a 536-bed teaching hospital in the United States. This consisted of five hospitals, two medical centers, and three urgent care centers. This Level II trauma center that
participated in the study contained a medical, cardiac, neuroscience and surgical intensive care unit. For this study, they used all patients that were admitted to a cardiac ICU and its step-down unit that required indwelling urinary catheters. This study was done over a three-month period in 2013 that recorded the occurrence of CAUTI, the rates of indwelling urinary catheters and the length that indwelling urinary catheters are in place prior to the implementation of nursing interventions specifically focused on indwelling urinary catheters. Wick’s Check-Plan-Do-Check-Act (CPDCA) model of continuous quality improvement was used during the project. Nurse driven protocols for the assessment and removal of indwelling catheters were implemented and nursing rounds for indwelling catheters were done every eight hours. The results from a nine-month period after implementation showed fewer CAUTIs (p=.009) and lower CAUTI rates (p=.005). The mean compliance for nurses performing indwelling catheter rounds three times per day was 91%. (Thomas, 2016).
In our next study, The Cochran Incontinence Group's Specialized Trials Register was examined. All randomized control trials (RTC) and quasi-RTCs comparing different types of indwelling catheters in patients that were catheterized for less than 14 days were used as the search criteria and 26 trials met the criteria. Studies showed that antiseptic-coated catheters may reduce the number of bacteria in the urine but did not reduce the presence of UTIs. Other studies did show that catheters coated with antimicrobials significantly reduce the number of bacteria in the urine and can reduce the incidence of patients developing a CAUTI. Overall, the type of catheter is not as important to reduce in incidence of CAUTIs as reducing the number of unnecessary catheterizations and their prompt removal (Lam, Omar, Fisher, Gillies, & MacLennan, 2014).
Nursing practice and assessment play a great role in the occurrence of CAUTIs within hospital patients. The Bladder Bundle is a protocol that can be used as a CAUTI prevention technique. With implementation of this bundle, nurses would increase their use of bladder scans, use catheter removal prompts, provide efficient catheter care, and use urinals and bedside commodes. Hospitals that implemented the Bladder Bundle saw a significant decrease in CAUTI rates. Removal prompts would make nurses and physicians aware of catheter duration and need for catheter removal. With prompts of catheter removal and use of alternative methods there was a decrease in catheter utilization, catheter days, and CAUTI rates (Dy, Major-Joyness, Pegues, & Bradway, 2016).
Bottom line: Since urinary tract infections are a common
hospital-acquired infection and many are caused by indwelling urinary catheters, nurses can be an important resource in the reduction of the occurrence of CAUTIs (Lam, Omar, Fisher, Gillies, & MacLennan, 2014). These infections have a significant impact on patient morbidity and an estimated 1 in 1,000 deaths per urinary catheterized patients are contributed to a CAUTI (Giles et al., 2015). Studies have shown that focused nursing assessments can reduce the occurrence of CAUTI in hospitalized patients. These assessments include identifying the need for an indwelling urinary catheter, prompt removal of the catheter, providing efficient catheter cares and choosing the correct type of catheter. Even though studies have shown a decreased risk of CAUTI with the implementation of focused nursing assessments, more research is needed to validate these results.
Implications for nursing practice:Proper catheter cares and insertion techniques
are important during a nursing assessment to prevent CAUTI infections. Having appropriate training, supplies, and performing routine catheter cares can help prevent the occurrence of these CAUTI infections. Insertion techniques effect the number of bacteria present and sterile technique must be followed to minimize the number of bacteria present upon insertion of an indwelling urinary catheter. We can educate our nurses about proper sterile technique and this can be practiced through staff education materials and hands on training. Catheters must also keep a closed drainage system to keep bacteria out of the urethra and bladder. Every time the system is opened, we are increasing the access point of bacteria to enter the bladder which then increases the risk of patients developing a CAUTI. Foley catheter drainage bags should only be emptied as needed and cleansed after each use (Underwood, 2015). Catheters should also be secured to the patient’s leg using an adhesive or Velcro securement device. If the catheter is not secured properly, it can piston back and forth which can then introduce bacteria on the outside of the catheter into the urethra which can then migrate to the bladder using capillary action. These implications for nursing practice can easily be implemented for the patient with an indwelling urinary catheter and help to reduce the risk of CAUTI occurrence. Nurses also need to be aware of the catheter duration and need for Foley catheters. This should be assessed regularly and often as the need for catheter can change with patient status. Nurses can be a part of this intervention and remind providers about the length of time a Foley has been placed.
CAUTI Infections
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Reprinted from American Nurse Today, Volume 13, Number 5
Investing in nurses to achieve global health.
Health should be a recognized universal right. Having an equitable health system should be a universal standard. And having highly skilled nurses recognized for their expertise in providing care and leading efforts to transform a nation’s health and health system should be a universal practice.
U.S. nurses are not alone in our quest to be a prominent voice at all tables in determining how to best shape and deliver healthcare. Just a few months ago, a three-year, global campaign was publicly launched called Nursing Now under the auspices of the Burdett Trust for Nursing in collaboration with the International Council of Nurses (ICN) and the World Health Organization (WHO). More than 30 countries, including the United Kingdom, Switzerland, South Africa, and the United States, were represented at launch-day activities held around the world. Catherine, Duchess of Cambridge, served as the official patron.
The Nursing Now campaign is focused on improving health globally by raising the profile and status of nurses worldwide. The agenda is ambitious, but it’s critically important and can be accomplished with real investment in nursing and ongoing support. Nurses and midwives make up the largest segment of the health workforce worldwide, and they can have a great impact on the health and well-being of individuals and communities because of their
The Nursing Now Campaign Launchesexpertise and extensive reach through their varied roles and settings.
That said, we’re facing a global shortfall of nine million nurses and midwives projected by 2030. The WHO Triple Impact report, whose findings helped initiate the campaign, also noted that although there is “enormous innovation and creativity in nursing,” nurses “are too often undervalued and their contribution underestimated.”
To achieve its vision, the campaign has developed goals that are similar to those outlined in the U.S.–focused Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health. Both the campaign and the report address advancing nurses’ education and professional development, including leadership skill-building and their ability to effectively function in rapidly evolving healthcare environments. The campaign and report also call for increasing nurses’ influence on health policy and engaging nurses in leadership roles at all levels. And both serve as clarion calls for investing in the nursing workforce and viewing nurses as the key to solving many healthcare-related issues.
Lord Nigel Crisp, former chief executive of the National Health Service in England, and co-chair of the international board leading Nursing Now, recently met with the ICN Executive Committee. In discussing ICN’s action plans for the campaign, Crisp reinforced the importance of engaging the world’s nursing leaders to make an indelible impact on global health, saying, “I believe that strengthening nursing is one of the single biggest things we can do to improve health globally. Nurses, wherever they are, are the health professionals closest to the community
and are invaluable in promoting health and preventing diseases as well as providing care and treatment.”
As the U.S. representative from the American Nurses Association to ICN and its first vice-president, I have the privilege of talking with nurses from many of the 130-plus member countries. I’ve learned that no matter our country of origin, nurses share the ability to identify patient and population needs; implement effective, and sometimes very creative, interventions; and understand that health promotion and preventive measures are critical to raising the health of patients, communities, and nations. Many of us also share similar struggles, although to varying degrees: staffing shortages, workplace and societal violence, emerging infectious diseases, and barriers to practicing to our full education and expertise. Addressing these, too, will help achieve the impact we want on global health.
The Nursing Now campaign will run to the end of 2020, which coincides with the 200th anniversary of Florence Nightingale’s birth and a worldwide celebration of nurses. I encourage all nurses to learn more about the campaign at nursingnow.org and to support each other in leading the way to helping people achieve health.
Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN President, American Nurses Association
Silver Spring, MD — The ANA Enterprise announced the appointment of Dr. Loressa Cole as its new Chief Executive Officer (CEO). She assumed this role on May 7, 2018.
In this role, Cole, DNP, MBA, RN, FACHE, NEA-
BC, will provide strategic leadership and have responsibility for the operating activities of the Enterprise including management of staff and implementation of programs for the American Nurses Association (ANA), American Nurses Credentialing Center (ANCC), and American Nurses Foundation.
Dr. Cole is an accomplished senior executive who brings more than 30 years of progressively higher leadership and management experience, most recently as Chief Officer and Executive Vice President of ANCC. ANCC promotes excellence in nursing and health care globally through credentialing programs, recognizes healthcare organizations that promote quality patient outcomes, and accredits healthcare organizations that provide and approve continuing nursing education. She has been with ANCC since 2016.
Previously, Dr. Cole held Chief Nursing Officer and Chief Operating Officer positions within the Hospital Corporation of America’s (HCA) Capital Division. While Chief Nursing Officer at LewisGale Montgomery Hospital, she led the hospital to attain ANCC Magnet® recognition. Among her many accomplishments, she championed year-over-year improvement in employee engagement and reduction in nursing turnover, as well as implemented several specialty and Service Excellence programs that helped establish the regional health system as a Joint
ANA Enterprise Appoints Dr. Loressa Cole as New Chief Executive Officer
Commission Top Performer and earned Leapfrog “A” rating for hospital safety.
“Dr. Cole is well prepared to lead and strengthen the evolving ANA Enterprise. She was selected from a field of outstanding candidates to fulfill this top leadership role for nursing,” said ANA President Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN. “She brings proven leadership as a seasoned healthcare executive and as the current Executive Vice President of ANCC. She demonstrates the vision, creativity, passion for nursing, and strong business acumen to leverage the strengths of ANA’s entities to enhance and grow the Enterprise.”
“I am very honored and excited to assume this prestigious position. The American Nurses Association is the professional association for all registered nurses, and a recognized leader in ensuring quality care for all Americans,” said Dr. Cole. “At 4 million and growing, America’s nurses outnumber all other health-care professionals and serve an essential role to protect, promote, and improve health for all ages. I am humbled to lead the organization that for more than a century has nobly represented and served our nation’s nurses. I look forward to working with the dedicated staff and volunteers who contribute tirelessly to maintain and grow the exceptional programs and credentialing products offered by the ANA Enterprise.”
Dr. Cole earned an associate degree in nursing from Bluefield State College in Bluefield, WV, a bachelor’s degree in nursing from Virginia
Commonwealth University in Richmond, VA, a master’s of business administration from Averett University in Danville, VA, and a doctorate in nursing practice from Case Western Reserve University in Cleveland, OH. She is a member of ANA, Virginia Nurses Association, American Organization of Nurses Executives, and the American College of Healthcare Executives, where she holds Fellow status. Additionally, she currently serves on the Journal of Nursing Administration’s Editorial Board and the Joint Commission’s Nursing Advisory Council. A past President of the Virginia Nurses Association and the Virginia Partnership for Nursing, Dr. Cole has also served on multiple boards, including The Bradley Free Clinic of Roanoke (VA), The Free Clinic of the New River Valley, and the Daily Planet (Richmond, VA).
The ANA Enterprise is the organizing platform of the American Nurses Association (ANA), the American Nurses Credentialing Center (ANCC), and the American Nurses Foundation. The ANA Enterprise leverages the combined strength of each to drive excellence in practice and ensure nurses’ voice and vision are recognized by policy leaders, industry influencers and employers. From professional development and advocacy, credentialing and grants, and products and services, the ANA Enterprise is the leading resource for nurses to arm themselves with the tools, information, and network they need to excel in their individual practices. In helping individual nurses succeed—across all practices and specialties, and at each stage of their careers—the ANA Enterprise is lighting the way for the entire profession to succeed.
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w Director, Division of Nursingw Clinical Nursing Instructor (Part-time)w Clinical Nursing Laboratory Technician (Part-time)
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