Inquiry in baccalaureate nursing education: fostering evidence-based practice

With the increasing emphasis on evidence-based nursing practice, nurse educators need to more fully implement teaching strategies that help students gain critical thinking skills related to inquiry and understand the importance of evidence-based nursing practice. Research and scholarship emphases in one baccalaureate nursing program, student-identified benefits, and challenges associated with incorporating inquiry across the curriculum are described in this article. In clinical journal entries, students described the following benefits associated with curricular emphasis on inquiry: increased interest in evidence-based nursing practice and participating in the generation of research; enhanced critical thinking skills through the development of knowledge, experience, and competencies; increased motivation to continue professional growth and development by participating in lifelong learning; the desire to become better consumers of research findings; better understanding of the "real world" of clinical research; and increased desire to pursue graduate studies in nursing. The challenge to promote student growth toward competence in the application of evidence-based principles in clinical practice is ongoing.     

The role of stress,peer influence and education levels on the smoking behaviour of nurses

Smoking kills yet a substantial number of qualified nurses continue to smoke. Stress, peer influence and education levels have been cited as influencing prevalence levels among nurses. A self-completed questionnaire was used to survey qualified nurses' perceptions of smoking prevalence, attitudes, and reasons for smoking. The respondents were composed of a random sample (n=1074) of qualified nurses employed in Northern Ireland. Results show that 25.8% of the sample smoked. Factors influencing smoking behaviour and reasons for continuing smoking are explored. This paper discusses the implications of these findings for nursing and nurses' health promotion activities.     

Effects of oral sodium picosulphate Picolax on urea and electrolytes

AIM: To investigate the effects of sodium picosulphate (Picolax) oral bowel preparation on levels of serum urea, electrolytes and glucose in patients undergoing bowel preparation for barium enema. METHOD: A prospective, non-randomised, pre-test and post-test trial was conducted with 144 patients aged 34-87 years, who had agreed to undergo a barium enema. Changes in serum urea, sodium, potassium, magnesium and glucose following Picolax treatment were investigated. RESULTS: There were statistically significant post-Picolax reductions in serum concentrations of urea (mean difference 0.556 (95 per cent confidence intervals (CI) 0.321-0.791) mmol/L), sodium (mean difference 1.299 (0.799-1.799) mmol/L) and potassium (mean difference 0.163 (0.0853-0.241) mmol/L). Similar findings were observed for sodium and urea when the sample was stratified according to age: under 60 years (n=56) or 60 years and over (n=88). However, there was no significant change in potassium in patients aged under 60 years. CONCLUSION: In normal circumstances, use of Picolax oral bowel preparation results in a statistically, but not clinically, significant reduction in concentration of serum urea, sodium and potassium.     

Intention to receive the seasonal influenza vaccine among nurses working in a long‐term care facility

The factors affecting influenza vaccine uptake among nurses might vary between different medical facilities. The purpose of the present study was to explore factors that affect the intention of nurses at a long‐term care facility to receive the influenza vaccine and whether the health belief model predicts this intention. In this cross‐sectional quantitative correlational study, a convenience sample of 150 nurses employed at a large long‐term care facility in central Israel completed a questionnaire based on the health belief model. Data collection took place between January and February of 2016. Forty‐two percent of the respondents reported having been vaccinated against influenza in the current year. The health belief model explained 53% of the variance (p < .01), with perceived (personal) benefits of the vaccine being the most significant factor. The number of times of receiving the influenza vaccine in the past was strongly correlated with the intention to receive the vaccine (p < .01). To improve nurses' compliance with influenza vaccination at long‐term care facilities, we find that it is necessary to emphasize the benefits of vaccination and, particularly, the personal benefits. Annual vaccination behavior should be promoted to make it become a routine.     

Cost-effectiveness of fluvastatin following successful first percutaneous coronary intervention

BACKGROUND: In the LIPS (Lescol Intervention Prevention Study), fluvastatin 80 mg/day reduced the risk of major adverse cardiac events (MACE) by 22% versus placebo (p = 0.01) following successful first percutaneous coronary intervention (PCI) in patients with stable or unstable angina or silent ischemia. The cost-effectiveness of such therapy is unknown. OBJECTIVE: To evaluate the cost-effectiveness of fluvastatin following successful first PCI from a US healthcare system perspective. METHODS: We used a Markov model to estimate expected outcomes and costs of 2 alternative treatment strategies following successful first PCI in patients with stable or unstable angina or silent ischemia: (1) diet/lifestyle counseling plus immediate fluvastatin 80 mg/day; and (2) diet/lifestyle counseling only, with initiation of fluvastatin 80 mg/day following occurrence of future nonfatal MACE. The model was estimated with data from LIPS and other published sources. Cost-effectiveness was calculated as the ratio of the difference in expected medical-care costs to the expected difference in life-years (LYs) and quality-adjusted life-years (QALYs) alternatively. RESULTS: Treatment with fluvastatin following successful first PCI was found to increase life expectancy by 0.78 years (QALYs 0.68). Cost-effectiveness of fluvastatin following successful first PCI is 13 505 dollars per LY (15 454 dollar per QALY) saved. Ratios are lower for patients with diabetes (9396 dollar per LY; 10 718 dollar per QALY) and those with multivessel disease (9662 dollar per LY; 11 076 dollar per QALY). Findings were robust with respect to changes in key model parameters and assumptions. CONCLUSIONS: Fluvastatin therapy following PCI is cost-effective compared with other generally accepted medical interventions.     

Auditory brainstem response classification: a hybrid model using time and frequency features

OBJECTIVE: The auditory brainstem response (ABR) is an evoked response obtained from brain electrical activity when an auditory stimulus is applied to the ear. An audiologist can determine the threshold level of hearing by applying stimuli at reducing levels of intensity, and can also diagnose various otological, audiological, and neurological abnormalities by examining the morphology of the waveform and the latencies of the individual waves. This is a subjective process requiring considerable expertise. The aim of this research was to develop software classification models to assist the audiologist with an automated detection of the ABR waveform and also to provide objectivity and consistency in this detection. MATERIALS AND METHODS: The dataset used in this study consisted of 550 waveforms derived from tests using a range of stimulus levels applied to 85 subjects ranging in hearing ability. Each waveform had been classified by a human expert as 'response=Yes' or 'response=No'. Individual software classification models were generated using time, frequency and cross-correlation measures. Classification employed both artificial neural networks (NNs) and the C5.0 decision tree algorithm. Accuracies were validated using six-fold cross-validation, and by randomising training, validation and test datasets. RESULTS: The result was a two stage classification process whereby strong responses were classified to an accuracy of 95.6% in the first stage. This used a ratio of post-stimulus to pre-stimulus power in the time domain, with power measures at 200, 500 and 900Hz in the frequency domain. In the second stage, outputs from time, frequency and cross-correlation classifiers were combined using the Dempster-Shafer method to produce a hybrid model with an accuracy of 85% (126 repeat waveforms). CONCLUSION: By combining the different approaches a hybrid system has been created that emulates the approach used by an audiologist in analysing an ABR waveform. Interpretation did not rely on one particular feature but brought together power and frequency analysis as well as consistency of subaverages. This provided a system that enhanced robustness to artefacts while maintaining classification accuracy.     

The meaning of home for ageing women living alone: An evolutionary concept analysis

The concept of home to women ageing should be visited in the light of ongoing cultural, political, temporal and disciplinary evolutions. In part, to compliment policies increasing focus on supporting older adults to age in place and a growing attention on the home as a place where healthcare is designed and provided. The following concept analysis utilises Rodgers’ evolutionary method to inductively analyse literature in order to elicit the meaning and experience of home among older women who are ageing at home. Literature was collected over an 18‐month period during 2014–2015 and the sample was made up of 49 articles. The analysis led to the concept of home among women ageing in communities to be defined by four attributes. These attributes are home as (i) a resource, (ii) an attachment, (iii) the precariousness of maintaining and sustaining home and (iv) a cultural expectation. This analysis of the meaning and experience of home among women ageing at home has shed light on the needs for this group of women, while highlighting the need to continue to further clarify and define the concept through research.