Applied nursing research : ANR
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Randomized Controlled Trial
Effects of an intervention to improve communication about end-of-life care among African Americans with chronic kidney disease.
The prevalence of and mortality from chronic kidney disease (CKD) are high among African Americans. Interventions to improve knowledge of the likely illness course and the benefits and risks of life-sustaining treatment at the end-of-life are needed for African Americans with CKD and their surrogate decision makers. Nineteen African Americans with stage 5 CKD and their surrogates were randomized to either patient-centered advance care planning (PC-ACP) or usual care. ⋯ At posttest, 90% of patients in the intervention group reported that they would choose to undergo cardiopulmonary resuscitation even if the chance of surviving the attempt would be low, whereas 57% of patients in the control group reported that they would make that choice. PC-ACP can be effective in improving patient and surrogate congruence in end-of-life treatment preferences. However, the results suggest a need for further improvements in the intervention to enhance cultural appropriateness for African Americans with CKD.
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This study examined types of errors that occurred or were recovered in a simulated environment by student nurses. Errors occurred in all four rule-based error categories, and all students committed at least one error. The most frequent errors occurred in the verification category. ⋯ The least common errors were related to coordinating information with the patient and family. Our finding that 100% of student subjects committed rule-based errors is cause for concern. To decrease errors and improve safe clinical practice, nurse educators must identify effective strategies that students can use to improve patient surveillance.
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The study's purpose was to identify dyspnea management strategies (DMS) perceived most effective by elders with end-stage chronic obstructive pulmonary disease (COPD). The mixed-method design also incorporated triangulation to compare results between qualitative and quantitative data. ⋯ Gender differences in preferred DMS were revealed. All participants (N = 30) preferred to use multiple strategies for effective dyspnea management; therefore, health care providers should consider employing individualized combinations of DMS when assisting elders with end-stage COPD during acute exacerbations of dyspnea.
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Comparative Study
Pain measurement during labor: comparing the visual analog scale with dermatome assessment.
The purpose of this article is to examine the agreement between two measures of pain in laboring women who receive epidural analgesia for relief to support validity and reliability of the Visual Analog Scale (VAS) in this population. ⋯ There was moderate, significant correlation between the two measures. However, agreement between the two measures did not meet preset standards with Bland-Altman analysis, suggesting that one measure cannot be substituted for the other. Overall, the average dermatome levels alone underestimated pain in laboring women as recorded by the VAS, although both under-and overestimation of pain relief occurred during the series of observations.