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Background: Global Cancer Statistics 2020 reported that breast cancer had exceeded lung cancer as the most frequently diagnosed cancer. Surgery is the primary treatment modality for breast cancer, but postoperative upper limb dysfunction often occurs; functional exercise can alleviate this and restore upper limb function. However, exercise compliance is low in postoperative breast cancer patients; thus, many studies have been conducted in recent years to improve patient compliance with exercise., Objective: The aim of this study was to compare the effectiveness of different interventions to improve exercise adherence in postoperative breast cancer patients., Methods: We searched PubMed, Cochrane Library, Web of Science, EMBASE, Wan Fang, CNKI, VIP, and CBM databases for eligible studies. Exercise adherence rate and quality-of-life difference were assessed as outcomes. Sensitivity analysis and inconsistency detection were performed to evaluate whether the exclusion of high-risk studies affected the validity. Risk of bias was assessed using the risk-of-bias table in RevMan 5.4. Surface under the cumulative ranking was used to estimate the rankings among different interventions., Results: Twenty-five randomized controlled trials involving 9 interventions were included, and the network meta-analysis results showed that patients in the pedometer + counseling group had the best exercise adherence., Conclusion: Pedometer + counseling care measures are recommended to improve exercise adherence in postoperative breast cancer patients., Implications for Practice: Oncology nurses can improve patients' exercise compliance through counseling and by giving them pedometers to wear., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Patients with lung cancer experience multiple symptoms requiring self-management. Little is known about how self-management is influenced by interactive health literacy, defined as communicating with healthcare providers to obtain and process information., Objective: This study explored how interactive health literacy relates to symptom self-management among patients with lung cancer. A second aim explored how interactive health literacy might be integrated into the Individual and Family Self-management Theory., Methods: This study used a cross-sectional mixed-methods design. Quantitative data included demographics, the All Aspects of Health Literacy Scale, and the Memorial Symptom Assessment-Short Form. Qualitative data were collected using semistructured interviews. Data analysis followed a critical realist model., Results: Twelve adults who recently received treatment for lung cancer reported an average of 14 symptoms that caused moderate distress. Average interactive health literacy of the sample was in the moderate range. Participants' experiences of self-management differed based on their interactive health literacy. A generative mechanism proposes that those with higher interactive health literacy who accessed online information used this information as a basis for engaging with providers regarding potential symptom self-management strategies., Conclusions: Interactive health literacy skills may play a role in patients' ability and confidence in symptom self-management through interactions with oncology providers. Further research should clarify the relationship between interactive health literacy, self-efficacy, and collaboration with oncology providers., Implications for Practice: The patient-provider relationship is a key factor influencing how patients obtain and process symptom self-management information. Oncology providers should implement patient-centered strategies to engage patients in symptom self-management., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: The human body possesses the unique ability to repair itself after injury through complex, sequential phases. Current development of advanced wound care therapies generally focuses on addressing a single aspect of this biological process that can result in delayed or ineffective wound healing. When patients present with further systemic and local confounding pathologies it can result in painful, chronic wounds that are especially challenging to treat.In this case report, the authors demonstrate how treatment with a novel multimodal wound matrix expedited healing and decreased pain in two patients who had each been unresponsive to treatment with advanced modalities for more than 7 months. The first patient had factor V Leiden and the second patient had sickle cell disease. Use of a once-weekly treatment protocol with the multimodal wound matrix, combined with sharp debridement when deemed clinically necessary, resulted in elimination of pain and expedited wound healing to closure. The wound matrix's omega fatty acid-based formulation is designed to target multiple factors common among hard-to-heal wounds that when not addressed, can adversely inhibit the wound-healing cascade., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc.)

Background: The nursing work environment is often stressful and can lead to burnout. The use of humor may help nurses adapt and cope. Although most would agree that, in general, humor can help build camaraderie and ease tense situations, little is known about how nurses use humor in their professional lives., Purpose: The study's main purpose was to explore how humor is used and perceived by nurses in the workplace., Methods: A sample of LPNs, RNs, and advanced practice RNs was recruited in the United States. Participants were interviewed via the videoconferencing platform Zoom. Data from the video recordings, audio transcripts, and investigators' field notes were analyzed using reflexive thematic analysis., Results: Sixteen nurses were interviewed about their use of humor, whether intentional or spontaneous, in the workplace. Three main themes were identified: entertainment, influencing others, and well-being. Participants reported using humor with self and others, including patients, families, and colleagues. Reported benefits include emotional regulation, relationship building, and work enjoyment. Some participants noted feeling insecure over when and whether the use of humor was "appropriate.", Conclusions: The results indicate that nurses' use of humor in the workplace had many benefits. Participants reported that humor could relieve tension, create bonds and strengthen relationships, and enhance both learning and work environments. Many recognized that humor can also be maladaptive and harmful, and that sensitivity and caution are part of using humor skillfully. Still, the benefits of humor appear to outweigh the risks. We conclude that humor is a useful tool nurses can and should use to optimize their nursing experience., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved. Unauthorized reproduction of this article is prohibited.)

Abstract: With nurses at the forefront of health care, the need for their active engagement in policy has never been more urgent. Numerous national and global reports call for nurses to lead policy change. The Patton Zalon Ludwick Policy Assessment Framework is intended to answer this call by serving as a foundational guide to nurses' self-assessment of their health policy actions. It includes three dimensions: engagement, partnership, and reach, each with three levels. The levels of engagement are literacy, advocacy, and influence. The partnership levels are single unit or community group, interdisciplinary team(s), and broad-based coalitions. The reach levels are based on the location of policy work: local/unit/organization, regional/state, and national/global. The dimensions are interconnected, and the levels build upon one another but are not necessarily symmetrical, linear, or prescriptive. In this article, the authors describe each dimension and level in detail, and the accompanying tables provide examples of policy goals and actions. Nurses worldwide can use this framework to engage in self-reflection and envision actions to achieve their policy goals. It will enable nurses to evolve from being policy bystanders to becoming visible, credible policy leaders., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved. Unauthorized reproduction of this article is prohibited.)

Study Design: Unblinded single-arm prospective clinical trial., Objective: Evaluate safety and accuracy of navigation for placement of posterior cervicothoracic instrumentation., Summary of Background Data: Computer assisted stereotactic navigation for placement of spinal instrumentation has been widely studied and implemented in the thoracic and lumbar spine. However less literature exists regarding the use of computer assisted navigation for posterior cervical instrumentation, particularly with lateral mass fixation. Here we present the first prospective study of navigated cervical lateral mass screw placement for cervicothoracic fusion., Methods: Patients who met indications for posterior cervical fusion were screened, consented, and enrolled preoperatively for instrumentation with Medtronic Infinity Occipital-Cervical-Thoracic implants, with use of intraoperative O-arm and stereotactic Stealth navigation. Postoperative CTs of the instrumented levels were obtained during the same hospital admission. Primary outcome of the trial was safety. Secondary outcomes were screw accuracy assessed by Gertzbein-Robbins grade, neurologic exams, and patient reported outcomes on the PROMIS 29 questionnaire., Results: A total of 50 patients underwent surgery, and 557 screws were placed. There were no adverse events related to the use of navigation or screw malposition. Gertzbein-Robbins grade A or B placement comprised 95% of navigated screws. There was a decrease in positive Hoffmann sign rate postoperatively, and sensory and motor exams remained stable. There was improvement in patient reported pain and sleep domains., Conclusions: Navigation for cervicothoracic instrumentation is safe overall and leads to high rates of accurately placed screws. Longer term follow up could provide more insight to whether the use of this technology results in durable improvement in spinal alignment parameters and patient reported outcomes., Level of Evidence: 3., Competing Interests: Conflicts of interest: DSX receives consulting support from NuVasive, Providence Medical Technologies. AJG and VSV receive consulting and research support from Medtronic and Nuvasive. Medtronic provided funding support for this study., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Competing Interests: The authors have disclosed that they do not have any potential conflicts of interest.

Competing Interests: The authors have disclosed that they do not have any potential conflicts of interest.

Editor's note: This is the next installment in a series on electrocardiogram (ECG) interpretation. Nurses in all settings should know the basics, as medications and physiological changes can cause cardiac arrhythmias. Each article will start with a brief case scenario and an ECG strip and then take you step by step through analyzing the heart rhythm., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: Rural communities in the United States are frequently marginalized and misrepresented. These communities face unique challenges, such as limited access to health care, nutritious food, and clean water, that contribute to persistent health disparities. This article presents the CARE (Complex, Access, Resourceful, Extraordinary) framework, which illustrates the dichotomy of rurality-its negative and positive aspects-in order to inform the development of palliative care delivery in rural settings. Various palliative care models are described that address access gaps, bolster provider capacity, and increase the provision of specialty palliative care. However, workforce shortages and reimbursement structures restrict the expansion of these services. Nurses, the largest segment of the health care workforce and the most trusted professionals, must partner with interdisciplinary colleagues and rural communities to advocate for equitable and inclusive care., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

A policy solution to improve staffing and patient care., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Identifying and acknowledging biases and working to eliminate them., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: In the United States alone, more than 100,000 people are waiting for a lifesaving organ transplant. In response to the growing need for viable organs to transplant, donor management centers have opened to provide care to brain-dead organ donors prior to the organ procurement operation. This article describes donor management center operations, details the opening of one such unit, and describes the results and lessons learned. More research is needed on the impact of nursing care on the specialized organ donor population., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: An ED admission and hospitalization are scary experiences for anyone, and potentially more so for nurses. Yet there is scant information about nurses as patients in the nursing research literature. This likely reflects a general tendency among researchers to study the needs of patients but not those of nurses., Objective: This qualitative phenomenological study sought to explore the lived experiences of nurses who were admitted as patients to a hospital directly from an ED., Methods: A sample of nurse patients 21 years of age and older and including various genders, nursing specialties, and diagnoses were recruited using maximum variation purposive sampling. A semistructured interview guide was created, and data were collected through individual interviews conducted either face-to-face or via telephone. Data were coded manually, and thematic analysis was conducted using Dedoose software., Results: The analysis revealed that many participants had experienced tremendous undue stress during their hospitalization. Four themes were identified: to tell or not to tell, pulling the nurse card, taking one's care into one's own hands, and having to make medical decisions while sick., Conclusions: The study findings indicate that nurses who are hospitalized have different needs than do hospitalized individuals in the lay population. The findings inform our recommendations, which health care organizations, nurse educators, and nurse leaders can use to promote smoother, more compassionate care for nurse patients. Staff nurses can use them to better prepare themselves for caring for a nurse patient-or becoming one. The study findings can also serve to guide future research., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Premedication administration to patients who are to receive blood transfusions continues despite evidence of a lack of benefit when given to prevent febrile nonhemolytic or mild allergic transfusion reactions. Reviews of ordering practices and staff surveys on an adult inpatient hematology-oncology unit in our multisite oncology medical center indicated a lack of standardization and overuse of premedication in blood transfusions and a lack of knowledge of when it was appropriate to use premedication., Methods: A literature search was performed, and the evidence led to a proposal for a quality improvement (QI) project focused on development of an evidence-based algorithm to guide clinicians in when to administer which premedication, development of clear documentation for premedication plans, integration of the documented premedication plans into electronic orders for blood products, and staff education. Interventions included a hospital-wide algorithm and an electronic order to be integrated with a premedication plan for each patient on the adult hematology-oncology unit., Results: Seven months after implementation of the intervention, premedication use among patients decreased by 57.6%, and the transfusion reaction rate decreased from 1% to 0.8%. Staff knowledge as measured by responses to pre- and postintervention surveys on the appropriate use of premedication also improved., Conclusion: Evidence-based interventions can reduce the incidence of premedication use in patients receiving blood transfusions., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: In 2018, the Centers for Disease Control and Prevention introduced the Adult Sepsis Event (ASE) definition, using electronic health records (EHRs) data for surveillance and sepsis quality improvement. However, data regarding ASE outside the United States remain limited. We therefore aimed to validate the diagnostic accuracy of the ASE and to assess the prevalence and mortality of sepsis using ASE., Design: Retrospective cohort study., Setting: A single center in South Korea, with 2732 beds including 221 ICU beds., Patients: During the validation phase, adult patients who were hospitalized or visiting the emergency department between November 5 and November 11, 2019, were included. In the subsequent phase of epidemiologic analysis, we included adult patients who were admitted from January to December 2020., Interventions: None., Measurements and Main Results: ASE had a sensitivity of 91.6%, a specificity of 98.3%, a positive predictive value (PPV) of 57.4%, and a negative predictive value of 99.8% when compared with the Sepsis-3 definition. Of 126,998 adult patient hospitalizations in 2020, 6,872 cases were diagnosed with sepsis based on the ASE (5.4% per year), and 893 patients were identified as having sepsis according to the International Classification of Diseases , 10th Edition (ICD-10) (0.7% per year). Hospital mortality rates were 16.6% (ASE) and 23.5% (ICD-10-coded sepsis). Monthly sepsis prevalence and hospital mortality exhibited less variation when diagnosed using ASE compared with ICD-10 coding (coefficient of variation [CV] for sepsis prevalence: 0.051 vs. 0.163, Miller test p < 0.001; CV for hospital mortality: 0.087 vs. 0.261, p = 0.001)., Conclusions: ASE demonstrated high sensitivity and a moderate PPV compared with the Sepsis-3 criteria in a Korean population. The prevalence of sepsis, as defined by ASE, was 5.4% per year and was similar to U.S. estimates. The prevalence of sepsis by ASE was eight times higher and exhibited less monthly variability compared with that based on the ICD-10 code., Competing Interests: Drs. Lim and Lee received support for article research from the Korea Disease Control and Prevention Agency (fund code 2019E280500, 2020E280700, 2021-10-026 to Dr. Lim). They disclosed government work. The remaining authors have disclosed that they do not have any potential conflicts of interest., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine and Wolters Kluwer Health, Inc.)