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Hope is the belief that this lived moment is not the last. The purpose of my project is to succinctly illustrate the beauty of the relationship between hope and hopelessness. My project was developed by intertwining my view of hope with those of others to form a poem. The poem reveals the necessity of one emotion to the other, as good cannot exist without evil; hope cannot exist without hopelessness. My profession, law, may have a firm basis in reason and appear to leave no room for the whimsy of hope, but my project reveals that without hope there is no ability to live let alone practice law.
Perinatal asphyxia affects an estimated 1 to 3 per 1,000 term infants. Asphyxia at birth can cause hypoxic-ischemic encephalopathy (HIE), which is attributed to 23% of neonatal deaths worldwide. Previously, infants with HIE were treated with standard intensive care interventions which resulted in high morbidity and mortality rates. Through new research discoveries, implementing therapeutic-induced hypothermia has resulted in more positive outcomes for these infants. This study focused on the beneficial outcomes of neurological and motor function in infants with HIE who underwent therapeutic-induced hypothermia. The data from this study was compiled from an evidence-based literature review and a review of the protocol from Nationwide Children’s Hospital. The results of our literature review showed that therapeutic-induced hypothermia, along with standard nursing surveillance, had a positive impact on morbidity and mortality in infants with HIE. However, more research needs to be completed on the neurological and developmental outcomes of treated infants after 22 months of age. The nursing profession requires knowledge of evidenced based research and practice and research in order to deliver high-quality patient care. Therapeutic-induced hypothermia is a treatment that has been shown to improve the quality of care provided for infants with HIE.
Medication errors are the number one most preventable adverse patient outcome. According to the Institute of Medicine’s 2006 report, at least 1.5 million people are harmed every year, and hospitals pay 3.5 billion dollars each year as a result of medication errors. A literature review using 24 research based articles was used to develop matrices for data analysis. The researchers chose to examine what the most common causes of medication errors are and what nurses can do to eliminate medication errors in the acute care setting. The most common causes for medication errors are broken into four categories: errors in drug preparation, errors in drug administration, personal factors, and organizational factors. Implications for nursing practice include following institutional policies, double checking medications, improving communication between multidisciplinary teams, participating in educational classes and self-study, using the drug library for IV pumps, and using critical thinking skills. Institutional precautions that help prevent errors include decreasing patient load, decreasing overtime, providing continuing education, providing spots checks for new graduates, and providing a safe environment for error reporting. Identified recommendations for research include improving data validity and measuring the effect of technology on medication administration.
The Joint Commission on Hospital Accreditation has identified patient safety, including fall prevention, as a major quality improvement standard, since up to 12% of all patients in a clinical setting experience at least one fall during their care. The purpose of this evidence evaluation review was to identify those factors which most significantly correlate with patient falls and organizational protocols or processes that have been found to reduce the incidence of patient falls on general adult medical-surgical units of acute care centers. A database search (CINAHL, PUBMED, and EBSCO) and subsequent review of literature were conducted; articles from 2005 to 2011 were screened and those meeting selection criteria were reviewed and categorized. Exercise intervention, client education, and selected patient fall identifiers are correlated with risk reduction. Staff awareness and attention to patient and environmental assessment are critical to quality improvement. Student nurse and staff nurse educational and organizational policy recommendations are proposed. Fall prevention contributes significantly to patient recovery and morbidity and reduces unnecessary health care costs.
Premature critically ill newborns often undergo multiple painful procedures. Treatment of this pain is controversial because health care providers have misconceptions about infants’ ability to perceive pain. Emerging evidence suggests that untreated early pain experiences may cause long-term alterations in neurodevelopment and emotional functioning. The purpose of this scholarly review was to determine how painful stimuli in premature infants affect their development. Relevant research articles were identified through a search of PubMed, CINAHL, and Cochrane Review databases, and searching bibliographies of other published studies. The review included over 25 research articles published from 2005-2011. Contrary to common beliefs regarding infant pain, all of the studies showed that premature infants of any gestational age do react to painful stimuli. Short-term effects include increased heart rate and decreased tissue oxygenation. Due to technical problems in many studies, no clear conclusions can be drawn about the long-term effects of early pain experiences. Nurses have a responsibility for using effective pharmacologic and alternative treatments to assure adequate pain control in these vulnerable infants who cannot verbalize their needs. More research is needed to evaluate how repeated pain experiences during infancy may affect later behavioral responses.
Pain is an under treated symptom of illness. Pain is influenced by the severity of the pain, how the pain is interpreted, past experience with pain, and thoughts of the future. Patients report inadequate pain relief at end-of-life (EOL). There is a lack of awareness and experience on behalf of health care providers (HCP) in providing pain management at EOL. The priority in treatment of terminally ill patients is to relieve suffering. We completed a critical review and summary of 20 research articles. Adequate use of opioids to control pain allowed some to reclaim their lives; however, inadequately managed side effects deprived some of a meaningful life. Patients reported better pain control with earlier treatment. Hospice provided care and support as the disease worsened. The HCP played a vital role in holistic care. Pain evaluation and quality of life (QOL) were important to understanding patient suffering. Forming a therapeutic relationship assisted patients in finding meaning and balance. Patients’ reports of pain were higher than the perceptions of the caregiver. HCP need to work with patients to develop unique plans of care to maximize QOL. Provider education is needed due to lack of awareness/experience with unrestricted opioid use.
Sexuality issues among Breast Cancer Survivors (BCS) become increasingly important as BCS transition from “survival” mode to the resumption of life-affirming activities. Although some studies have identified sexuality issues among BCS, few have examined the perspective of their romantic partners (RP). The purpose of this study is to describe the sexuality concerns and educational needs of both BCS and RP. Respondents were recruited via electronic mailings to the Komen Columbus BCS database and postings to online discussion groups; 84 BCS and 45 RP completed valid open and closed response surveys. BCS and RP can have divergent information needs. BCS age, relationship status, and treatment modality were significantly related to problems with sexuality. Measures of caregiving burden failed to show a statistically significant relationship with RP sexuality concerns. This is one of the first studies to explore sexuality issues among RP. This study is also notable for its inclusion of individuals in a committed same sex relationship, 10.7% of BCS, 22% of RP respondents. Study results indicate a need for further exploration of the breast cancer experience in the context of same sex relationships, as well as for dyad-based research.
Hope can be achieved in many ways. This project provides an understanding of how hope can be gained through the art of dance. The purpose of this research was to describe how the experience of dancing influences the expression of hope. The investigator choreographed a developmentally appropriate dance targeted to help adolescent students express emotions about a situation that occurs frequently in junior high school, specifically bullying. The dancers were taught the choreography and asked to dance. Immediately following the dancing, students were interviewed and asked to describe what they learned about hope from the movement. The results showed that adolescents were able to express feelings and gain a better understanding of hope through dancing. This research suggests that dance could help children express hope in difficult situations.
Hyperglycemia is linked to adverse effects and complications, including increased infection rate, morbidity and mortality, in adult post-operative cardiac patients. The purpose of this study was to determine the effects of intensive perioperative insulin therapy versus conventional cardiac surgical management for adult diabetic patients on overall outcomes. The evidence-based practice methodology used included extensive literature review of research articles from 2006 through 2011. Selection criteria are defined including peer-review and quasi-experimental or experimental design. Evidence was evaluated using published EBP evaluation criteria. Results were inconclusive; however, current studies suggest that reduced glucose of >30 mg/dl during the first 24 hours post-operatively is associated with a lower risk of 30-day mortality. Hyperglycemia appears to be an independent predictor of short term infections post-operative surgical complications and possibly incidence of stroke. Implications surrounding the use of intensive insulin therapy include significant risk of hypoglycemia and costs associated with increased nursing staff for safe, continuous monitoring of each patient. More extensive research and interdisciplinary protocol development is needed to determine the feasibility of intensive insulin therapy and overall outcomes.
Pediatric patients who suffer traumatic brain injury (TBI) frequently survive and require recovery. The neuroplasticity in the pediatric patient presents recovery challenges. In the developing brain, under stimulation may result in synaptic pruning that eliminates neural connections which may result in growth and cognitive delays. Nurses working with pediatric TBI patients must be aware of stimuli to promote development and formation of neural connections. A systematic review was conducted by search of CINAHL, EBSCOhost, and MEDLine databases for literature published from 1996 to 2011. Specific articles were selected for evidence review based on selection criteria. Results suggest there are positive and negative stimuli that affect the developing pediatric brain. These effects are dependent upon age, cause of specific injury, severity of injury, and time of implementation. The research shows evidence that clustering care may minimize negative effects of TBI, while encouraging family interaction may promote positive effects on recovery. Little long term outcomes are documented and further research needs to be done concerning possible long term effects regarding age, cause of specific injury, severity of injury, and timing of implementation of interventions.
People living in areas of the world where high latitude impacts the amount of ultraviolet light exposure are at risk for low serum 25-hydroxyvitamin D, which can lead to diseases such as rickets, osteoporosis, bone fracture, cardiovascular disease, colorectal cancer, and influenza. The purpose of this literature review was to examine the prevalence and severity of low serum 25-hydroxyvitamin D in areas of high latitude with low UV light. A review the literature using EBSCO databases, including CINAHL, revealed 252 citations of which 10 citations were chosen because of their close relation to the topic. The findings include an emphasized overall serum 25-hydroxyvitamin D insufficiency among all of the subjects. The sun was found as the best way to maintain and improve healthy levels of serum 25-hydroxyvitamin D in many of the research studies reviewed. Serum 25-hydroxyvitamin D was found to have an effect on various diseases and increases in vitamin D serum status positively correlate with improvement in disease states. This study contributes to the study of nursing because nurses must be aware of the low serum 25-hydroxyvitamin status and the effect it has one their patients’ healing and disease states.
Hope is emotion embedded deep within our hearts that is necessary for survival. In times we experience failure, we endure a loss of hope. Many people around the world turn to music to gain the inspiration needed to find hope. I interviewed a variety of people to determine how beneficial music has been in their life, and how music helped to instill hope within them. I found no difference in age, language, or culture. Music is a universal expression of hope. I believe hope carries us through life, and music helps to heal us in times of despair. My prayer is for you to be able to find hope in your life, and when you are searching for inspiration, I hope you may find peace in music.
Professional recognition is critical to the evolving role of nursing. Many nurses today cannot easily be distinguished from other support persons and nursing leaders are discussing the need to move to a standardized uniform as an indicator of distinctive professional status. The purpose of this review is to evaluate what is known about the impact of various nursing uniforms on patient and family perception of the nursing profession. A systematic literature search resulted in selection of fifteen articles for an evidence-based evaluation of attitudes and perception of professionalism based on dress. Patient perceptions vary depending upon age and past experience in healthcare. Adult patients perceive nurses in standard uniforms to be more professional and competent. Pediatric patients may not associate professionalism with attire and prefer multi-colored, unconventional scrubs. Overall, evidence indicates that distinct, recognizable uniforms influence patients’ perceptions of nursing professionalism and abilities. Nursing schools and hospital administrators need to consider this data when implementing uniform policies.
When confronted with life events, people may respond with hope, hopelessness, or uncertainty. Responses depend on cultural background, age, gender, psychosocial, and environmental factors. I believe that being hopeful may support people through the tough times and enable them to move forward. The purpose of this project is to define hope, hopelessness, and uncertainty, and their characteristics, and to offer strategies designed to help people become more self-aware. After reviewing research papers and reflecting on my own personal experiences, I created a model that depicts my definition of hope, hopelessness, and uncertainty and showed it to a number of people. Based on their reactions to the model, I developed a poster. I expect people to become more self-aware of ways to build their own hope despite difficult circumstances.
Currently, 60% of women in labor receive epidural anesthesia. However, significant physiologic side effects occur, putting women and fetuses at risk for complications. Yet, little attention is given to educating women about the potential seriousness of epidural side effects. Little research attention regarding the significance of complications is evident in the recent literature. The purpose of this project was to explore the risks and side effects of epidural analgesia to provide evidence to support the development of nursing education guidelines for pregnant women. A literature review of 70 articles and a qualitative synthesis of the most frequently occurring complications are presented. Twelve maternal and two fetal complications were seen across these studies. Significant complications such as hypotension (50%), instrumental delivery (92%), and cardiac arrest were noted. An exaggerated perception of the safety of routine epidural anesthesia is evident among medical and nursing staff despite the evidence to the contrary. Recommendations for more objective and ethical education of antepartum women regarding comfort management in labor are offered. Recommendations for resocialization of nurses regarding comfort management for laboring women are presented.
Thousands of nurses every day engage in a ritual that is unique to their profession—the shift-change report. What happens and is conveyed during this routine process is of growing interest because of its implications for patient safety, information security, and continuity and quality of care. The purpose of this review was to examine shift-change reporting in acute care medical-surgical centers in the U. S. and to identify those systems that have shown improved patient care and inter-professional communication. An extensive search of research published in the last five years (CINAHL, Cochrane and PubMed databases) was conducted; articles were selected based on defined selection criteria, and outcomes were categorized according to standardized evidence evaluation criteria. Key findings indicate that standardizing bedside reporting reduced incongruities or omissions in information communicated among professional caregivers and improved care quality as well as nurse-patient communication. Continuous patient-centered care requires the accountability and structure of bedside reporting; therefore, standardized reporting formats should be adopted by professional staff. The system increases patient safety and quality and improves staff efficiency.
According to Miller and Newton (2006), chronic pain is becoming increasingly prevalent in our society. It is important for the Registered Nurse to understand the existence of gender differences in pain perception. By gaining this knowledge, nurses can better assist our patients in the management of pain. Because statistics reveal that there are gender differences regarding an individual’s perception and tolerance of pain, it is important to gain further understanding in this area of study. Recent evidence-based research showed that women had lower pain threshold and tolerance than men, which is consistent with earlier research study findings (Soetanto, 2006). Women were also identified as reporting pain more often than men.
Hope is a paradoxical concept including hope and hopelessness; it is both an emotion and an action. Hope is light in a world of dark and a continuous reciprocal process. The purpose of the project is to contrast two perspectives of hope through artwork. The investigator used a camera to capture hopeful and hopeless moments from two individuals and interviewed those individuals for their perspectives. The results are expected to show some differences between perspectives; however, some themes should emerge. This project helps others to understand that while hope may be different for individuals, there are some universal themes throughout.
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