The purpose of this research was to understand the modern experience of stress among adult coronary artery bypass grafting (CABG) patients who are hospitalized less than 10 days and among their significant caregivers. The naming of stressors and the nature and triggers for the stress response that either contributed to or ameliorated stress were examined. A qualitative research method using hermeneutic phenomenology was used to interpret and understand the experience of stress. The stressors identified by both patient and family participants in this study were shock and disbelief leading to a feeling of being overwhelmed. Among patients, mortality was foremost. Among family caregivers, anger was expressed. The importance of providing information, honesty, and trust were pivotal to alleviating stress. A more thorough knowledge of history and complementary therapies are needed to reduce stress.
• Background Neuromuscular blocking agents used for therapeutic purposes, such as facilitating mechanical ventilation and relieving life-threatening agitation, paralyze patients but leave them fully conscious. Aggressive sedation or analgesia is necessary to reduce awareness, relieve fear, produce comfort, decrease anxiety, induce unconsciousness, and minimize possible complications such as posttraumatic stress syndrome. Little information is available on the extent to which patients experience awareness during therapeutic paralysis. • Objectives To determine and describe the remembered experiences of critical care patients who were given neuromuscular blocking agents and sedatives and/or analgesics to facilitate mechanical ventilation, improve hemodynamic stability, and improve oxygenation. • Methods A phenomenological approach with in-depth interviews with 11 patients was used. Data were analyzed by using the constant comparative approach. • Results A total of 4 themes and 3 subthemes were identified. The first theme was back and forth between reality and the unreal, between life and death; the subtheme was having weird dreams. The second theme was loss of control; the 2 subthemes were (1) fighting or being tied down and (2) being scared. The third theme was almost dying, and the fourth theme was feeling cared for. • Conclusions Patients can remember having both negative and positive experiences during neuromuscular blockade. Steps to improve the experiences of patients receiving neuromuscular blockers include improving assessment parameters, developing and using sedation/analgesia guidelines, and investing in quality improvement programs to provide assessment of awareness during therapeutic paralysis and follow-up and referral as necessary. Ways to decrease the use of neuromuscular blockers would also be useful.
Shared governance (SG), a process for empowering nurses in practice settings, has been widely used for decades. However, despite enthusiasm for the concept, the process is not always successful or falters after successful initiation. To assist nursing leaders trying to implement or maintain SG processes, the author summarizes literature on both human and structural factors that contribute to the success or breakdown of SG practice models. Barriers to implementation and strategies to support implementation, as well as enculturation of SG, are discussed.
The practice environment is important to nurse satisfaction and patient outcomes. Laschinger and Leiter posited causal relationships by development and testing of the Nursing Worklife Model (NWLM). Using a secondary analysis of unit-level data (N = 3,203; medical, surgical, medical-surgical, critical-care, and step-down units) from the 2011 National Database for Nursing Quality Indicators®, hypothesized pathways of the NWLM were tested using structural equation modeling. Practice Environment subscales developed by Lake were used to operationalize model variables with job enjoyment being the outcome variable. Positive pathways identified in the original causal model were supported. However, using an iterative process, additional pathways were identified that improved model fit (comparative fit index = 0.99; root mean square error of approximation = 0.06; standardized root mean square residual = 0.002). Nurse manager ability, leadership, and support had direct links to job enjoyment as well as other elements of the model. Development of nurse managers is important to the retention of clinical nurses in the hospital setting.
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