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An understanding of nurse well-being remains elusive, particularly in the current toxic health care environment. Therefore, a conceptual definition of nurse well-being is needed.The purpose of this paper is to report results of a concept analysis of nurse well-being.Rodgers' Evolutionary Method of concept analysis was used to examine the attributes, antecedents, consequences, and related concepts of nurse well-being.Findings revealed varying levels of nurse well-being: individual, organizational and community. Individual attributes included happiness, satisfaction, optimism, compassion, gratitude, forgiveness, and sound body/spirit. Organizational/community attributes included teamwork, sense of mission, pride in work, and social integration. Antecedents reflected commonalities with Maslow's hierarchy of needs, ranging from basic human needs to self-actualization. Consequences included resilience, collegial relationships, continued growth and development, empowerment, purposeful work, and physical/mental health.Standardized definitions of individual and organizational/community nurse well-being should guide future research and policy development. Organizations must build capacity for nurses' well-being and explore its connection to patient safety and quality outcomes.

Purpose The purpose of this study was to investigate associations between postoperative delirium (POD) and unplanned perioperative hypothermia (UPH) among adults undergoing noncardiac surgery. Design A retrospective, exploratory design was used. Methods A retrospective, exploratory study was conducted using electronic medical record data abstracted from a purposive convenience sample of adult patients undergoing noncardiac surgery from January 2014 to June 2017. Findings The analyzed data set included 22,548 surgeries, of which 9% experienced POD. Logistic regression indicated that American Society of Anesthesiologists (ASA) class was the strongest predictor of POD (χ2 = 1,207.11, df = 4, inclusive of all ASA class terms). A significant relationship between UPH and POD (χ2 = 54.94, df = 4, inclusive of all UPH terms) and a complex relationship among UPH, patient age, ASA class, and POD were also found. Conclusions Results support a relationship between UPH and POD. Notably, there is also a complex relationship in the noncardiac surgery population among UPH, age, ASA class, and POD. Preliminary understanding of this relationship is based on the pathophysiological response to surgical stress. Further research is indicated.

Background and PurposeSecondary traumatic stress (STS) results in detrimental effects in healthcare professionals, impacting the safety of patients and their care. There are multiple instruments being used to measure STS, reflecting the uncertainty on how to best measure STS. The purpose of this review is to present an overview of the state of measurement of STS.MethodsPubMed, CINAHL, and Cochrane Database of Systematic Reviews databases were searched using the terms “secondary traumatic stress” AND “measurement.”ResultsThe search resulted in nine applicable articles and four instruments used to measure STS. Utility and psychometric properties of the instruments are examined.ConclusionsThe secondary traumatic stress scale (STSS) is most appropriate to measure STS given that it is the only instrument intended to measure only STS, but psychometric testing with nurses is needed.

The incidence of postoperative nausea and vomiting (PONV) is unknown in neuraxial anesthesia for orthopedic surgery. The effect on PONV of adding gabapentin to an evidence-based antiemetic regimen as part of an opioid-sparing analgesic protocol is also unknown in this population. A retrospective analysis of all adults undergoing hip and knee arthroplasty and receiving neuraxial anesthesia in 2017 was conducted. The overall incidence of PONV was assessed. Additionally, PONV incidence was assessed for all combinations of gabapentin, dexamethasone, and/or ondansetron (in addition to propofol infusion) and compared with propofol alone. The PONV risk ratios were estimated, adjusting for age and PONV risk score. The overall incidence of PONV was 14.0%. The addition of gabapentin to propofol was associated with reduced PONV (multivariable risk ratio [mRR], 0.6; 95% CI, 0.4-1.0) vs propofol alone. Dexamethasone with propofol was associated with reduced PONV (mRR 0.6; 95% CI, 0.4-1.1) vs propofol alone, although not statistically significant. The addition of both gabapentin and dexamethasone to propofol was associated with stronger reduction in PONV (mRR 0.3; 95% CI, 0.1-0.7) vs propofol alone. Adding ondansetron to propofol showed little benefit. Gabapentin and dexamethasone are effective in reducing PONV in patients undergoing knee and hip arthroplasty with neuraxial anesthesia.

Background Clinical practice guidelines are intended to bridge the research-practice gap, yet little is known about how critical care nurses adopt guidelines. Feeding tube verification practices remain variable and have led to patient harm and death. Objectives To examine factors influencing critical care nurses' adoption of the American Association of Critical-Care Nurses (AACN) practice alert on verification of feeding tube placement and its 4 recommended clinical practices. Methods Critical care nurses were invited to participate in a national, online questionnaire, guided by Rogers' diffusion of innovation framework. Descriptive statistics and logistic regression were used for data analysis. Alpha level was set at 0.05. Results Fifty-five percent of the 370 participating nurses were aware of the practice alert, and 45% had adopted it in practice. Only 29% of the adopters had also implemented all 4 clinical practices. Significant predictors of adoption included BSN or higher nursing education and guideline characteristics of observability and trialability. Predictors of implementation of the clinical practices included staff nurse/charge nurse role, academic medical center, research/web-based information sources, and perception of a policy. Policy was the only significant predictor of implementation of all 4 practices. Adoption of the practice alert was also a predictor for 2 of 4 clinical practices. Conclusions Personal and organizational factors influenced implementation of practices associated with an AACN practice alert. Although a research-practice gap exists, the practice alert was a significant source of information for 2 of the clinical practices.

Problem Stroke is the fifth highest cause of death and the leading cause of long-term disability in the United States. North Carolina has one of the highest death rates from stroke in the nation. Access to acute stroke care in rural western North Carolina is limited, with only one primary stroke center within an 18-county region. Angel Medical Center, located in rural western North Carolina, sought to pursue The Joint Commission's disease-specific certification as an Acute Stroke Ready Hospital in an effort to improve stroke care and outcomes across the region. Methods A multidisciplinary team of ED clinicians, hospital leadership, and community participants was formed to develop a structured care algorithm and intensive process improvement initiatives to guide the Acute Stroke Ready Hospital application process. Results In the 7 months since implementation, door-to-laboratory results have improved by an average of 12 minutes, door-to-computed tomography interpretation has improved by 3 minutes, time to intravenous thrombolytics has improved to less than 60 minutes, and patient transfer within 2 hours of arrival has also improved. ED provider average response time has been reduced by 5 minutes, and time to neurology via telemedicine has been reduced by almost 10 minutes. Implications for Practice By driving best practices in the delivery of stroke care, Angel Medical Center enhanced stroke care in a rural community, allowing patients and families to receive evaluation and treatment in a timely and efficient manner close to home.

BACKGROUNDThe American Association of Critical-Care Nurses practice alert on verification of feeding tube placement makes evidence-based practice recommendations to guide nursing management of adult patients with blindly inserted feeding tubes. Many bedside verification methods do not allow detection of improper positioning of a feeding tube within the gastrointestinal tract, thereby increasing aspiration risk.OBJECTIVESTo determine how the expected practices from the American Association of Critical-Care Nurses practice alert were implemented by critical care nurses.METHODSThis study was part of a larger national, online survey that was completed by 370 critical care nurses. Descriptive statistics were used to analyze the data.RESULTSSeventy-eight percent of nurses used a variety of methods to verify initial placement of feeding tubes, although 14% were unaware that tube position should be confirmed every 4 hours. Despite the inaccuracy of auscultation methods, only 12% of nurses avoided this practice all of the time.CONCLUSIONSImplementation of expected clinical practices from this guideline varied. Nurses are encouraged to implement expected practices from this evidence-based, peer reviewed practice alert to minimize risk for patient harm.

The American Society of PeriAnesthesia Nurses (ASPAN) highly regards evidence-based practice (EBP) as a guide to promoting "Best Practices" and improving patient outcomes. EBP is now considered the "gold standard" in improving patient care through the use of the best available evidence. EBP models provide the health care provider with a rigorous systematic method of rating and appraising the evidence that includes, but is not limited to, randomized controlled trials, descriptive studies, qualitative studies, national guidelines, and expert opinion. ASPAN's EBP Team was charged with the development of an EBP Conceptual Model to provide the framework for future perianesthesia practice, education, and research. This article describes how ASPAN's EBP model may be used as a framework for practice and research.