current resident or

Presort StandardUS Postage

PAIDPermit #14

Princeton, MN55371

ContentsPresident’s Message . . . . . . . . . . . . . . . . . 1Special Offer to all Nurses . . . . . . . . . . . . 3Are You Considering a Nursing Doctoral Degree? . . . . . . . . . . . . . . . . . . 4Being the Voice of Professional Nursing for ND-NDNA . . . . . . . . . . . . . . . . . . . . . 6Incivility in Nursing: Can’t We All Just Get Along? . . . . . . . . . . . . . . . . . . . 7EBP Student Abstracts . . . . . . . . . . . . 8-13Neonatal Therapeutic Hypothermia for Hypoxic-Ischemia . . . . . . . . . . . . . . 14

Inside

Vol. 83 • Number 2 May, June, July 2014

THE OFFICIAL PUBLICATION OF THE NORTH DAKOTA NURSES ASSOCIATIONCirculation 16,000 To All Registered Nurses, LPNs & Student Nurses in North Dakota

1912-2012

Special Offer to all Nurses!

Page 3

EBP Student Abstracts

Page 8-13

CelebratingNationalNursesWeek

May 6–12, 2014

ANA and the New Mexico Nurses Association areempowering nurses with resources, programs andstandards that help you advance your career and your profession.

Benefits include:

• Free and discounted continuing education modules

• Exclusive discounts on certification through theAmerican Credentialing Center

• Free subscriptions to ANA journals and newsletters

• Support for ANA’s advocacy efforts, which helpprotect your practice and improve the quality of care

Now is the perfect time for you to join ANAand the New Mexico Nurses Association

www.joinana.org

JOIN ANA & NMNA NOW!

May 6-12, 2014, is a special time whennurses from every practice specialty jointogether to celebrate National NursesWeek. This year's theme highlights thenursing profession's critical leadershiprole as health care continues to evolve.

Celebrate National Nurses Week 2014 by joiningANA and the New Mexico Nurses Association

10% off of your first-year membership dues if you join ANA and the

New Mexico NursesAssociation by June 30.

To receive this offer, completethe membership applicationon the reverse side or go to

www.joinana.org and usecode NNW14.

Roberta Young

Greetings North Dakota Nurses,Happy Birthday Florence Nightingale! The

American Nurses Association’s 2014 theme for National Nurses Week is “Nurses Leading the Way,” exactly what Florence did . ANA states, “Every day nurses step forward embracing new technologies, resolving emerging issues, and accepting ever changing roles in their profession . They lead the way for their patients, colleagues, organization, and the health care industry as a whole .” (nursingworld .org)

Embracing new technologies, resolving emerging issues and accepting ever changing roles . I hope you take a few moments to reflect on your leadership and how you have stepped forward in these realms of nursing practice . We have the opportunity to continue to integrate technology to enhance our critical thinking, coordination of care, and document the value and contribution of nursing care . Technology can bring huge frustration to our day but it has done wonders in helping us compile data to analyze the outcome of our care . One aspect of technology that I embrace is solidifying the control patients have over their own information, such as lab results, decision making tools, differential diagnosis models, and faster communication with their providers . We need to run fast to change our practice to welcome this new form of partnership with the patients we serve .

Nurses are posed to lead the way in resolving emerging health issues . Nurses often see the problems and issues developing before other health care leaders . I urge you to find your voice in these matters, to articulate the need and the path of collaboration in finding resolutions . North Dakota is experiencing a gap in behavioral health care and resources . Nurses are poised to creatively fill this gap . Our health model has always included the viewing of the person in the whole . We understand and have expertise in assessing the interaction of the physical with the emotional, with the spiritual

health of a person . School Nurses, Long Term Care Nurses, Ambulatory Care Nurses, Acute C a r e N u r s e s , Emergency Care Nurses, and the whole of our scopes, are really working as behavioral health nurses, or have the opportunity to do so . NDNA wants to support nursing leaders to step into this role to smooth the path of better health with advocacy and expert care .

Nurses week would be a wonderful time to join NDNA, take the step . Some of you are members of your specialty organizations . Great! They serve an important role in advancing the clinical expertise of our specialties . There are many issues though, that affect all nurses regardless of practice level or specialty- our right and responsibility to advocate for patients without fear of retaliation, ensuring that there is a nursing workforce strong enough to care for our aging population, or continual persistence to have nurses work at the fullest scope of their practice . Some benefits of joining NDNA are a subscription to a great profession journal, American Nurse, access to continuing education, and the ability to advance important advocacy issues .

During Nurses Week ANA is offering a free webinar for all nurses members or not, on Wednesday May 7th at noon . The speakers will be Bernadette Mazurek Melnyk PhD, RN, CPNP/PMHNP, FNAP, FAAN and Tim Porter-O’Grady, DM, EdD, ScD(h), APRN, FAAN, GCHS-BC . Details can be found at ndna .org .

We welcome you to participate in this learning, that you take time to refresh your leadership during Nurses week and that you take the leadership step of joining NDNA . Happy Nurses Week!

Xi Kappa at Large Chapter of Sigma Theta Tau International Honor Society for Nursing held its annual Induction Ceremony, Saturday, November 2, 2013 .

The induction recognizes nursing students and community nurse leaders who have demonstrated achievements in nursing, leadership qualities and high professional standards .

Inductees consisted of graduate and undergraduate students from the following colleges: Concordia College, Moorhead

NEWS RELEASE

State University Moorhead, North Dakota State University, and Jamestown College .

Congratulations to the new inductees!!

Concordia College - Undergraduate: Tonya Kay Anderson Alexa Kristin Bateman Jenna Jean Bakken Karissa Joy DeSautel

News Release continued on page 2

Page 2 Prairie Rose May, June, July 2014

The Prairie Rose Official Publication of:

North Dakota Nurses Association

General Contact Information:1-888-772-4179info@ndna.org

(This email is received by the NDNA President)

OfficersPresident: Vice President–Roberta Young Membership ServicesRoberta .Young@ Tammy Buchholzsanfordhealth .org tammy .buchholz@ sanfordcollege .edu

Vice President– Vice President–Communications Government Relations Amanda Erickson Kristin Roersamanda .erickson81@ Kristin .Roers@gmail .com sanfordhealth .org

Vice President– Vice President–Finance Practice, Education,Donelle Richmond Administration, ResearchDonelle .Richmond@ Julie Bruhnsanfordhealth .org julie .bruhn@va .gov

Published quarterly: February, May, August and November for the North Dakota Nurses Association, a constituent member of the American Nurses Association, 6070 173rd Ave SE, Walcott, ND 58077 . Copy due four weeks prior to month of publication . For advertising rates and information, please contact Arthur L . Davis Publishing Agency, Inc ., 517 Washington Street, PO Box 216, Cedar Falls, Iowa 50613, (800) 626-4081, sales@aldpub .com . NDNA and the Arthur L . Davis Publishing Agency, Inc . reserve the right to reject any advertisement . Responsibility for errors in advertising is limited to corrections in the next issue or refund of price of advertisement .

Acceptance of advertising does not imply endorsement or approval by the North Dakota Nurses Association of products advertised, the advertisers, or the claims made. Rejection of an advertisement does not imply a product offered for advertising is without merit, or that the manufacturer lacks integrity, or that this association disapproves of the product or its use. NDNA and the Arthur L. Davis Publishing Agency, Inc. shall not be held liable for any consequences resulting from purchase or use of an advertiser’s product. Articles appearing in this publication express the opinions of the authors; they do not necessarily reflect views of the staff, board, or membership of NDNA or those of the national or local associations.

Writing for Publication in the Prairie Rose

The Prairie Rose accepts manuscripts for publication on a variety of topics related to nursing . Manuscripts should be double spaced and in APA format . The article should be submitted electronically in MS Word to info@ndna .org . Please write Prairie Rose article in the address line . Articles are peer reviewed and edited by the RN volunteers at NDNA . Deadlines for submission of material for 2014 Prairie Rose are March 24, June 23, September 22 and December 23.

Nurses are strongly encouraged to contribute to the profession by publishing evidence based articles . If you have an idea, but don’t know how or where to start, contact one of the NDNA Board Members .

The Prairie Rose is one communication vehicle for nurses in North Dakota .

Raise your voice .

The Vision and Mission of the North Dakota Nurses Association Vision: North Dakota Nurses Association, a

professional organization for Nurses, is the voice of Nursing in North Dakota .

Mission: The Mission of the North Dakota Nurses Association is to promote the professional development of nurses and enhance health care for all through practice, education, research and development of public policy .

You are cordially invited to join the North Dakota Nurses Association

See the NDNA Website at www.ndna.org8 Click on Membership

Under how to join8 Click on Membership Application (ANA website)

8 Click on Full Membership(Be ready to provide your email address)

Full membership is just $20.50/ month! Less than 70¢ a day!

The Mission of the North Dakota Nurses Association isto promote the professional development of nurses and enhance health care for all

through practice, education, research and development of public policy.

Published by:Arthur L . Davis

Publishing Agency, Inc .

http://www.ndna.org

Elsa Linnae HokansonSarah Elizabeth JohnsonKaylee Brooke NorlinDanielle Georgette OlausonJenna Ann ScneibelKatie Kay SchroederAnita Marie SorensenCatrina Patrice Walter

University of Jamestown – Undergraduate:Caitlin Mae ArnoldKatie Marie BjertnessAmy Marie BuxaKayla Lynn ByleMiranda Bea Irene CharleyJessica Lynn KopeKalai LundquistAbigail Jo NillKelsey Marie SmithWhitney Marie StreifelJackie Renae ThomasMelany Ann Triebold

Minnesota State University Moorhead – Undergraduate:

Elizabeth KiffmeyerAlyssa NovakJennifer Tomford

Minnesota State University Moorhead – Graduate:

Stacy ChristensenKaren Rae GozellRebecca Love GullicksonJanell Faye HrdlickaKimberly Lehrke

North Dakota State University – Undergraduate:

Alexis AakreMolly BlairHeather BrusehaverDanielle EidenschinkCaitlin Giesen

News Release continued from page 1 Haley JohnstonHannah KnettelAmber KrachtCourtney KrausJennifer KuntzHannah LinzLesley LockenVivian NgongangStephanie SchwenkJaclyn SmithRebecca TheedeTara UehranEmily Van Den Einde

North Dakota State University – LPN-BSN Undergraduate:

Chelsea EllefsonAngelea VanhornSamantha Plooster

North Dakota State University – Graduate:Collette ChristoffersKeshia KotulaSun Mi Chol

Community Nurse Leaders:Emily Buckingham, BSN, RNMary Douglas, MSN, RNJanet Drechsel, MSN, RNPaula Duval, MSN, RN, BSHCA, CNOR, CNMLErica M Evans, MSN, RN, CWCN Stacy Lund, MSSL, BSN, RN, CNORMargaret Nelson, EdD, MSN, MSHCA, RN, CNMLCrystal Nemer, MSN, RN, CNMLShelby Quinn, MBA, BAN, RNEvelyn Telford, BSN, RNBonnie Vangerud, MSN, RN, CCRN, CNML

In addition to the induction, scholarships were also given to the following:

Xi Kappa Scholarships – Graduate Recipients:

Alena Deutschlander – MSUMKolby Schaeffer – NDSU

Xi Kappa Scholarships – Undergraduate Recipients:

Amy Buxa – University of Jamestown Abigail Nill – University of Jamestown Melony Triebold – University of JamestownAmber Kracht – NDSU

Martha Vorvick Berge Scholarship:Jaclyn Smith - NDSU

May, June, July 2014 Prairie Rose Page 3

CelebratingNationalNursesWeek

May 6–12, 2014

ANA and the North Dakota Nurses Association areempowering nurses with resources, programs andstandards that help you advance your career and your profession.

Benefits include:

• Free and discounted continuing education modules

• Exclusive discounts on certification through theAmerican Nurses Credentialing Center (ANCC)

• Free subscriptions to ANA journals and newsletters

• Support for ANA and NDNA's advocacy efforts, which help protect your practice and improve the quality of care

Now is the perfect time for you to join ANAand the North Dakota Nurses Association

www.joinana.org

JOIN ANA & NDNA NOW!

May 6-12, 2014, is a special time whennurses from every practice specialty jointogether to celebrate National NursesWeek. This year's theme highlights thenursing profession's critical leadershiprole as health care continues to evolve.

Celebrate National Nurses Week 2014 by joiningANA and the North Dakota Nurses Association

10% off of your first-year membership dues if you join ANA and the

North Dakota NursesAssociation by June 30.

To receive this offer, completethe membership application at

www.joinana.org and usecode NNW14.

Rear-Facing: Keep children rear-facing until at least two years of age or until the maximum size limits of the car seat.

Forward-Facing: Use a forward-facing car seat until the maximum size limits of the car seat.

Booster Seat: After children outgrow a car seat with a harness (at least 4 years of age and 40 lbs.); use a booster seat until they are 4’9” tall - between 8-12 years of age.

Seat Belt: Use a seat belt only when it fits a child’s body correctly. The lap belt must ride low on the hips and the shoulder belt must lay centered across the chest.

For brochures, training, car seat checkups and more information call 1.800.472.2286.

http://www.ndhealth.gov/injuryprevention/childpassenger/

Child Passenger SafetyBest Practice Recommendations

Director of Nursing and RN positions available

CMC offers competitive wages, excellent benefits, shift differentials, student loan reimbursement & more!

View CMC’s numerous employment opportunities on our website, www.coopermc.com

Contact tanyah@coopermc.com or (701) 797-2221.

BSN required - prior nursing experience preferred. Must be currently licensed as a RN in ND and have a valid ND

driver’s license. Must be able to lift at least 15 pounds.Responsible for overall management and supervision of

comprehensive public health program in Emmons County.

Submit resume to: Emmons County Public Health, PO Box 636, Linton, ND 58552

Emmons County Public Health is a tobacco-free environment. Because of the duties of this position, the applicant must not be a tobacco user. Salary and benefits based on

experience and qualifications. EOE

Emmons County Public HealthPublic Health Nurse Administrator

Do You Participate?By Kristin Roers, MS RN

Vice President of Government Relations, NDNA

“We in government do not have government by the majority.

We have government by the majority who participate.”~Thomas Jefferson

“Nursing as a profession has arrived at a prestigious point in development where the word “nurse” now is synonymous with the words “patient advocate,” thus giving the specialty an important image to fulfill . The public, however, will not recognize nurses as patient advocates until they begin to champion public health and social issues at the Institutional, community, and national levels . (Des Jardin, 2001) .” This is from an article written in 2001 – and 13 years later, we are still in the same situation – where nurses need to step up and get involved, to be aware of the power and influence they have in the area of health care legislation and reform .

The Basics:• Laws:theWhat(ex–AffordableCareAct)• Rules/AdministrativeCode:theHow(ex–CMS

Regulations)¡Frequently when we bemoan a law, it is

actually the rules/regulations set by a regulatory agency that make it cumbersome

• By understanding the moving parts in thelegislative process, we can be more successful in our attempts to effect change

What are a couple issues in North Dakota that I should be aware of?• Community Paramedics – understanding the

needs and rationale for the program, and effects on nursing

• “Find the Good Life in North Dakota” – a statewide campaign to attract 20,000 workers to ND, including to the healthcare sector

Where can I get more information on Nursing & Legislative Affairs?• NDCenterforNursing:Advocacy–http://www .

ndcenterfornursing .org/advocacy-center/• American Nurses Association: Policy &

Advocacy – http://www .nursingworld .org/MainMenuCategories/Policy-Advocacy

References:Des Jardin, K . E . (2001) . Political involvement in

nursing—education and empowerment . AORN, 74(4), 467-475 .

No Campus Visits Liberal Credit Transfers Competitive Tuition Classes That Fit Your Schedule

$4,000 Sign On Bonus for LPNs and RNs in LTCDavid “White Thunder” Trottier, Director

Human Resource Department

www.hamc.com800 Main Avenue S., Rugby, ND 58368

(701) 776-5261 • (701) 776-5043 TDD • (701) 776-2933 Faxdtrottier@hamc.com

Page 4 Prairie Rose May, June, July 2014

Julie Bruhn MS, RN Associate Director Patient Care Services, Fargo VA Health Care System. Vice President NDNA Practice, Education,

Administration and Research.

The IOM Report on the Future of Nursing contains recommendations to double the number of nurses with a doctorate by 2020 . This would not only prepare nurses to assume increasingly complex leadership assignments, regardless of the practice setting, but would also support the need for nurse faculty and nurse researchers, which can lay a critical foundation in building the future of nursing in leading change and advancing health .

Pursuing a doctorate degree can be a life changing decision and there are some important aspects to consider in selecting a nursing doctoral program . In addition to choosing a particular school, you also need to consider the type of program that is the best fit for you and your professional goals; be it a PhD (Doctor of Philosophy in Nursing) or a DNP (Doctor of Nursing Practice) .

The following questions can help guide you in your decision-making . There is value in each type of program and the roles nurses can hold with either degree .

Which degree fits best with my career goals and professional interests?• If your career path is that of aNurse Researcher or Research Scientist

in either an academic setting or a research-intensive clinical setting, consider a PhD (a research doctorate) . Roles also include that of Faculty or Administrator .

• If your career path is one that emphasizes clinical responsibilities, suchas a Nurse Practitioner, Clinical Nurse Specialist, Certified Nurse Anesthetist, Administrator, or Clinical Nurse Faculty, consider a DNP (a practice doctorate) .

Questions to consider regarding a specific program or university for a PhD or DNP education: • IstheschoolaccreditedbyeithertheNationalLeagueforNursing(NLN)

(for PhD and DNP programs) or the Commission on Collegiate Nursing Education (CCNE) (for DNP programs only)? Non-accredited programs may not be recognized by all employers .

• What is the reputation of the program?What are the requirements foradmission? Examine the school rankings; sources include one of the national weekly journals (i .e . US News and World Report), a consumer report, or a research funding report (such as an NIH report) .

• How long has the program been in existence? Does it have a record ofsuccessful graduates?

• Is the program part time or full time? Which one fits your goals andpriorities?

• Doestheprogramrequirethatyourelocate,andifso,isthatpossible?Isit a predominantly in-person, classroom program; mixed online and in-person; or partially or exclusively online?

• Doestheprogramallowforyoutohaveaone-on-onefacultymentor?• What is the typical length of a student’s program of study? Howmany

students graduate within the typical period? Be wary of programs in which many students do not graduate “on-time .” This may indicate a lack of adequate mentoring .

• What is the availability of student support services, such as editorialreview, librarian, statistical assistance, Information Technology (IT) support, and peer support services for students?

• Howmany students are admitted each semester / year? Is each studentassigned a specific advisor? What is the student to faculty ratio? High faculty to student/advisee ratios may indicate lower quality mentoring .

• Is the school non-profit or for-profit? Students attending for-profitinstitutions may have limited access to low-interest student loans or other forms of financial aid (Korn, 2012) .

Issues specific for the PhD Program: • How many faculty serve as principal investigators on funded research

projects?• Dofacultyregularlypublishinpeer-reviewedjournals?• Do faculty have federally-funded grants (e.g., National Institutes of

Health [NIH], Veterans Health Administration [VHA], Agency for Health Research and Quality [AHRQ]) or grants funded by private foundations (e .g ., American Cancer society [ACS], Robert Wood Johnson Foundation [RWJF], Sigma Theta Tau International [STTI])?

• Does any member of the faculty in the school conduct research in thearea in which you are interested? For example, if you want to do genetics research but the program specializes in heart disease… .this may not be a good match . There needs to be a good match with faculty research programs at the university .

Issues specific for the DNP Program: • Whattypeofcapstoneprojectisrequired(eg,evidencesynthesis,evidence-

based practice project, evidence based quality improvement, research)? Does the coursework prepare students adequately for conducting a capstone project? Ask to see a sample capstone project .

• Howmanydidacticandclinicalhoursarerequiredforcompletion?• HowmanytracksarethereintheDNPprogram,forexample,clinicalor

administrative?• In what areas of scholarship are faculty involved, e.g., quality

improvement, evaluation, policy change, leadership? • What are your personal considerations about work life, school life, and

personal/family life related to continuing your education?• Whatareyourcareeraspirationsaftercompletingyourdoctoralstudy?• Whataretheexpectedtotalcostsforcompletingtheprogram?(Howmuch

debt are you willing to incur?) What scholarships are available? Does the

Are You Considering a Nursing Doctoral Degree? college have an individual dedicated to helping students obtain scholarship monies and/or financial aid? What is the average amount of student financial aid provided for most of the students who attend this school’s program?To further assist you in making your decision, the following chart

compares the PhD and DNP roles:

PhD (Doctor of Philosophy in Nursing)

DNP (Doctor of Nursing Practice)

Objective:Prepares graduates in nursing

science to conduct independent research that advances the empirical and theoretical foundations of nursing . The research generates new knowledge of generalizable findings and adds to the body of knowledge .

Objective:Prepares graduates in nursing

practice to be leaders and role models in applying and translating research evidence into practice . Practice doctorates include development and validation of expertise in one or more area(s) of specialized advanced nursing practice (eg, NP role, leadership role, clinical faculty role) .

Program of Study:Focus is research, usually

on a narrowly defined area; the PhD graduate aspires to become the expert in this defined area by contributing to the body of knowledge about this topic . Dissemination of research findings through peer-reviewed presentations and publications is expected . Prepares nurses for faculty positions with research careers in research-intensive universities or as researchers in public or private healthcare systems (AACN, 2010)

Usually 4 years (full-time) or more; a post-doctoral fellowship is often encouraged

Program of Study:Focus is practice that is oriented

toward improving outcomes of patient care (AACN, 2006) . Prepares nurses to assume clinical leadership roles in health care delivery systems, complex clinical environments, and evidence-based practice (Udlis & Mancuso, 2012)

Usually 2 years (full time)

Competencies and Content:Prepares one to conduct

independent research . The curriculum includes courses

on statistics, research, methods, and theory courses to develop knowledge and skills in theoretical, methodological, and analytic approaches to the discovery and application of knowledge in nursing and healthcare .

The PhD program core focus is on nursing theory and research methods and the development of competencies to expand science that supports the discipline and practice of nursing (AACN, 2010)

Competencies and Content:Graduates are capable of

analyzing and using research, through translation into practice and quality improvement .

The curriculum includes courses on advanced clinical practice, including both practice and patient management, organizations, systems and leadership skills, use of evidence to improve practice, informatics, health systems, health policy, and factors which influence healthcare outcomes for individuals, populations, and organizations

The DNP program builds on traditional master’s programs by providing education in evidence-based practice, quality improvement, and systems leadership, among other key areas to develop knowledge and skills in applying and translating research into practice (AACN, 2012) .

Also includes a clinical practicum or residency requirements

Program Faculty:Possess research doctorate

(typically a PhD) in nursing or related field

Demonstrate sustained research funding

Are recognized as experts in their research area (AACN 2006)

Scientific rigor is evident through numerous peer-reviewed publications and presentations

Program Faculty:Possess a nursing practice

doctorate; some faculty may have a research doctorate in nursing or related field

Demonstrate expertise in a specific practice area

Demonstrate leadership experience in specialty practice

Scientific rigor is evident

Program opportunities:Currently there are 120

research-focused doctoral programs in nursing with another eight in the planning stages (AACN, 2010) . Not all programs are created equal, is the research training solid?

Program opportunities:Currently there are 184 DNP

programs and an additional 101 DNP programs are in the planning stages (AACN, 2012) . Not all programs are created equal; does the program prepare you adequately for the role you are seeking?

Considering a Nursing Doctoral Degree continued on page 5

May, June, July 2014 Prairie Rose Page 5

PhD (Doctor of Philosophy in Nursing)

DNP (Doctor of Nursing Practice)

Program Outcome:Prepares graduates to function

as leaders in nursing research, serving in roles such as nurse scientist in academia or a research-intensive practice environment .

The graduate is prepared to develop a program of research .

The PhD is recognized worldwide

The PhD is considered in academe as the entry-level degree for an assistant professor on a tenure track .

Program Outcome:Prepares graduates as clinical

practice leaders in nursing, serving in roles such as an advanced practice nurse or healthcare administration .

Graduates are prepared to conduct clinical improvement projects; focus is on translating current evidence into practice .

DNP education prepares graduates and ensures their eligibility to sit for national, advanced specialty certification (Mancuso & Udlis, 2012)

Resources:Mentors and/or preceptors in

research settingsAccess to research settings with

appropriate resourcesAccess to funding to cover

tuition and dissertation studiesAccess to information and

research technology resources congruent with program of research (AACN, 2010)

Resources:Mentors and/or preceptors in

leadership positions across a variety of practice settings and access to diverse practice settings with appropriate resources for areas of practice

Program is part of a comprehensive university or university medical campus

Access to financial aidAccess to information and patient-

care technology resources congruent with areas of study (AACN, 2010)

Final Project and Eligibility for certification:

P r o g r a m c o m p l e t i o n requires successful completion of coursework, program-level examinations (for example, progression exams at the end of core courses), conduct and defense of dissertation

Does not include preparation to sit for national certification exam in a practice area

Final Project and Eligibility for certification:

Requires capstone or scholarly project grounded in clinical practice and designed to solve practice problems or to inform practice directly

Graduates may be eligible for national certification exam if professional practice requirements are met

Program assessment and evaluation:

Oversight by the university’s authorized bodies (i .e ., graduate school) and regional accreditors (AACN, 2006)

Program assessment and evaluation:

Receives accreditation by specialized nursing accreditation agency (CCNE, 2012)

Source: Veterans Health Administration, Office of Nursing Services, Nursing Research Advisory Group 20140301

BibliographyAmerican Association of Colleges of Nursing . (2012) . DNP fact sheet .

Retrieved from http://www .aacn .nche .edu/media-relations/fact- sheets/dnpAmerican Association of Colleges of Nursing . (2010) . The research-focused

doctoral program in nursing-Pathways to excellence . Retrieved from http://www .aacn .nche .edu/education-resources/phdposition .pdf

American Association of Colleges of Nursing . (2006) . V . AACN Contrast Grid of the Key Differences between DNP and PhD/DNSc/DNS Programs . Retrieved from http://www .aacn .nche .edu/dnp/Contrast

Grid .pdfAmerican Association of Colleges of Nursing . (2001) . Position statement

on quality indicators for doctoral programs . Washington, DC: Author .CCNE (Commission on Collegiate Nursing Education) . (2012) . Frequently

Asked Questions: DNP Programs & CCNE Accreditation . Retrieved from http://www .aacn .nche .edu/ccne-accreditation/DNP-FAQs .pdf

Cleary, M ., Hunt, G .E ., & Jackson, D . (2011) . Demystifying PhDs: A review of doctorate programs designed to fulfil the needs of the next generation of nursing professionals . Contemporary Nurse, 39, 273-280 .

Cowan, L ., Fasoli, D .R ., Hagle, M .E ., Kasper, C .E ., Eagerton, G ., Chappell, J ., …Alt-White, A . (2013) . Creating an Infrastructure to Advance Nursing Practice and Care for Veterans . Nurse Leader, 11(5), 33-36 . doi:10 .1016/j .mnl .2013 .05 .019

Korn, M . (2012, October 24) . For-Profit Colleges Get Schooled . The Wall Street Journal . Retrieved from http://online .wsj .com/article/SB10001424052970203937004578076942611172654 .html

Mancuso, J . M ., & Udlis, K . A . (2012) . Doctor of nursing practice programs across the United States: A benchmark of information . Part II: Admission criteria . Journal of Professional Nursing, 28(5), 274-283 . doi: 10 .1016/j .profnurs .2012 .01 .002

Minnick, A . F ., Norman, L . D ., Donaghey, B ., Fisher, L . W ., & McKirgan, I . M . (2010) . Leadership in US doctoral nursing research programs . Journal of Nursing Education, 49(9), 504-510 .

Minnick, A . F ., Norman, L . D ., Donaghey, B ., Fisher, L . W ., & McKirgan, I . M . (2010) . Defining and describing capacity in US doctoral nursing research programs . Nursing Outlook, 58, 36-43 .

Perry, J .A . (2012) . To Ed .D . or not to Ed .D .? Kappan Magazine, 94(1), 41-44 . Slyer, J ., & Levin, R .F . (2012) . On the Doctor of Nursing Practice (DNP) .

Research and Theory for Nursing Practice, 2691), 6-9 . Tanner, C . (2013) . In J . Simani, Letter to the Editor . NursingMatters,

24(1), 9 . Retrieved from http://epaperflip .com/aglaia/viewer .aspx?docid=3d71504c67a0401984e6b1a2dd13a4ed

Udlis, K . A ., & Mancuso, J . M . (2012) . Doctor of nursing practice programs across the United States: A benchmark of information . Part I: Program characteristics . Journal of Professional Nursing, 28(5), 265-273 . doi: 10 .1016/j .profnurs .2012 .01 .003

PhD / DNP comparisons from a sampling of academic programs: Boise State University School of Nursing . (n .d .) . Key differences between

PhD and DNP doctoral programs . Retrieved from http://hs .boisestate .edu/nursing/files/2013/02/Phd-DNP-Distinguishing-Characteristics .pdf

Duke University-School of Nursing . (n .d .) Comparison of DNP and PhD programs . Retrieved from http://nursing .duke .edu/academics/programs/dnp/dnp-phd-comparison

Johns Hopkins University-Bloomberg School of Public Health . (n .d .) . Degree programs . Retrieved from http://www .jhsph .edu/academics/degree-programs/

University of Nebraska Medical Center-College of Nursing . (n .d .) . Doctoral programs in nursing – DNP or PhD? Retrieved from http://www .unmc .edu/nursing/Doctoral_Programs_in_Nursing-DNP_or_PhD .htm

Considering a Nursing Doctoral Degree continued from page 4

Page 6 Prairie Rose May, June, July 2014

Donelle Richmond and Roberta Young

This edition of the Prairie Rose is being brought to you by your North Dakota Nurses Association (NDNA) Board of Directors . We believe that it is important to get information about professional nursing practice and advocacy to the nurses of ND . Becky Graner has been the Editor of the Prairie Rose for several years, finding and editing content, and contributing many articles of her own . The NDNA Board of Directors has a deep appreciation for Becky and the high quality work she put in to every edition .

NDNA is a constituent member of the American Nurses Association; ANA . Some states have state association only membership options, but NDNA has only one, meaning if you belong to NDNA you automatically belong to ANA .

The mission of NDNA is to advance the nursing profession by promoting professional development of nurses, fostering high standards of nursing practice, promoting the safety and well-being of nurses in the workplace, and by advocating on health care issues affecting nurses and the public . Structurally we accomplish these through our 5 Task forces:

• GovernmentRelations:ContactisKristinRoers MSN, RN

• Membership:ContactisTammyBuchholzMSN, RN

• Communication:ContactisAmandaEricksonBSN, RN

• Finance: Contact is Donelle Richmond BSN, RN

Being the Voice of Professional Nursing for ND-NDNA

• ProfessionalPractice,Education,Administration and Research: Contact is

Julie Bruhn MSN, RN

Operationally we use a virtual office supported by the Mid-West Multistate Division, and soon a contracted staff person .

We have several communication vehicles; email at info@ndna .org, Web site www .ndna .org, Facebook and of course through our partnership with Arthur Davis Publishing to produce the Prairie Rose on a quarterly basis in print and online . The NDNA Board of Directors in interested in knowing how you would like to see this publication evolve . In particular we would like the Prairie Rose to be a place where you could publish articles that promote the professionalism of nursing in ND and advocacy for health care issues that affect both the advancing of nursing practice and the health of our communities .

You can become involved . We know there are expert nurses in all corners of our state . Expert nurses are usually experts at passing on value and knowledge through stories . It is one of the best ways adults learn . Please take the opportunity to share learning through this vehicle . If you have an article to share, please email us at info@ndna .org .

You can also become involved by joining NDNA . There is no better time than right now . We need your ideas, your voice, and your expertise from all walks of nursing, from all parts of ND . As you will see we are collaborating with ANA to offer a 10% discount on your first years membership if between now and June 30th 2014 . We do this in honor of Nurses Day . Nurses do Lead the way and what better way to step up to this challenge but to join NDNA, your professional nurses association .

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May, June, July 2014 Prairie Rose Page 7

Research study author: Anne Eliason, MSN, RN Submitted by Tammy Buchholz, MSN, RN

Incivility permeates our society, and the nursing profession has not been immune . Incivility as defined is a lack of regard for others (Andersson & Wegner, 2001) and is an issue that affects all aspects of nursing . Acts of incivility by nurses in the work environment create barriers to effectiveness in patient care settings . If nurses chose civility as a normal standard for interactions with one another, the efficacy and communication of the team would be greatly improved . This in turn would create a positive work environment which would enhance job performance and ultimately improve patient outcomes .

Incivility is also seen in the nursing educational setting . Perceptions of incivility in classroom settings are critical to the success or failure of teaching-learning environments . In nursing education, incidences of incivility in classroom and clinical settings have increased over the past decades . Perceptions of incivility vary between students and faculty members . Students may not perceive that their own behaviors are disruptive and may continue those behaviors . Faculty members may perceive that those same student behaviors exhibited are uncivil and may assume that these acts were done with malice .

To examine incivility in nursing education, a mixed methods study regarding incivility was conducted in two baccalaureate nursing programs in a Midwestern state . One program was in a private religious-based university and the other was in a state funded university . The Incivility in Nursing Education survey was administered to sophomore, junior and senior nursing students and their faculty during the months of April and May, 2010 . The survey consisted of three sections: demographics, perceptions of specific behaviors in the classroom that were considered being uncivil, open-ended questions regarding personal opinions and experiences of incivility . A total of 234 surveys were returned and analyzed .

Key definitions for the study and survey used were based on work done by Clark (2008, 2009) . Civility as defined by Clark and Carnasso (2008) is “an authentic respect for others when expressing disagreement, disparity, or controversy . It involves time, presence, a willingness to engage in genuine discourse, and a sincere intention to seek common ground .” Clark and Farnsworth (2009) defined incivility as “rude or disruptive behaviors which often result in psychological or physiological distress for the people involved and if left unaddressed, may progress into threatening situations .”

It is difficult to determine exactly where the cycle of incivility in nursing begins, but the cycle continues full circle . The beginning may be nurse faculty incivility to a student nurse, who then when he or she becomes a licensed nurse, is uncivil to his or her fellow nurse colleague, who then becomes a nurse faculty and continues the cycle .

In the research study conducted, both student and faculty groups agreed there was a mild to moderate amount of incivility in each of the nursing programs . The findings from both groups were consistent in identifying the particular behaviors that they found the most uncivil .

The study findings regarding threatening behaviors included: challenges to knowledge or credibility, general taunts or disrespect, vulgarity directed at others, inappropriate e-mails and

IncivilityinNursing:Can’t We All Just Get Along?

threats of physical harm . The groups agreed the incidences of incivility affected teaching-learning environments in a negative manner . Students tended to be slightly more likely to engage in uncivil behaviors than faculty .

Study participants suggested solutions to the problem of incivility in the classroom . Recommendations included that class standards of behavior be established during class orientation and that incidences of uncivil behavior be addressed immediately .

Other recommendations include strategizing to eliminate acts of incivility as a group experience and the need for clear communication in all relationships . Once understanding of this issue is increased, there should be mutual problem-solving to reduce the incidences of incivility in academic and healthcare settings . Administrators must put forth policies that will not tolerate uncivil behavior by anyone in the healthcare setting .

Nurses need to support each other . Some of the ways in which we can do this include: clearly outlining expectations of each other up front, role-modeling the behavior that we want to see, showing respect for others’ time and talents, immediately quelling acts of incivility in a mutually agreed upon manner and supporting lively, and courteous discourse .

Creating civil teaching-learning environments will benefit students and faculty . Ultimately the development of more respectful environments will have a domino effect that will serve to improve workplace communication and the quality of patient care .

References:American Nurses Association . (2005) . Code of ethics for

nurses with interpretive statements . Washington, DC: American Nurses Publishing .

Andersson, L ., C . Pearson, and C . Wagner . (2001) . When workers flout convention: a study of workplace incivility . Human Relations 54: 1387-1419 .

Boice, B . (1996) . Classroom incivilities . Research in Higher Education, 37(4), 453 .Retrieved September 25, 2009, from EBSCO Metafile database

Brady, M . (2010) . Healthy nursing academic work environments . The Online Journal of Issues in Nursing, 15(1), Man06 . Retrieved June 19, 2010, from the World Wide Web .

Caza, B ., & Cortina, L . (2007) . From insult to injury: Explaining the impact of incivility . Basic & Applied Social Psychology, 29(4), 335-350 . Retrieved September 25, 2009, doi:10 .1080/0197353

Clark, C . (2008a) . Student voices on faculty incivility in nursing education: A conceptual model . Nursing Education Perspectives, 29(5), 284-289 . Retrieved September 25, 2009, from CINAHL Plus with Full Text database

Clark, C . (2008b) . Faculty and student assessment of and experience with Incivility in Nursing Education . Journal of Nursing Education, 47(10), 458-465 . Retrieved September 25, 2009, from CINAHL Plus with Full Text database

Clark, C . (2008c) . The dance of incivility in nursing education as described by nursing faculty and students . Advances in Nursing Science, 31(4), E37-54 . Retrieved September 25, 2009, from CINAHL Plus with Full Text database

North Dakota Nurses Association – Working

for YouNDNA has several new communication

tools . We are striving to provide timely information to members .• NDNA now has a new phone number and

service . 1-888-772-4179 . Add it to your contacts .

• NDNA has new website that will link toimportant information for you including active advocacy, opportunities to be involved, and nursing news . We were able to keep our same address: http://www .ndna .org

• NDNA members should be receiving thenew weekly Mid-West Multi State Division email newsletter called “Lighting the Way . . .Professional RN Update .” We would love to send this to any ND nurse who is interested . If you want to receive it, please email NDNA at info@ndna .org .

• We would love to connect with you onFacebook! Take the opportunity to like us!

Another important step NDNA is taking is hiring a Director of State Affairs . We feel that this position will help us optimize the benefits of being part of the Mid West Multi State Division . We also want to be posed to be the voice of advocacy for health access and advancing the practice of nursing in our state . The NDNA Board also knows that a virtual office is great and efficient, but we also want to be able to provide valuable timely, membership service . This part-time contracted position will help us achieve this . Please consider this role, or recommend it to a nurse you know that may be looking for this type of opportunity .

If you are interested or know of someone who would be interested in this 20 hour per week contracted position as the NDNA Director of State Affairs, please read more: Responsibilities would include: membership service and growth support, communications, social media presence, nursing advocacy, sustain collaborative networks, and maintain NDNA virtual office . Qualifications include:• 3+ year’s leadership experience and/or

project management . • ABachelor’sdegreeinnursingispreferred.• Proficient use of Microsoft Office Suite is

essential . • Musthaveattentiontodetail.• Strong written and oral communication

skills .• Team-player who is customer-service

minded both internally and externally .

If you are qualified and interested, please send your cover letter, resume, and salary requirements to: NDNA at 6070 173rd Ave . SW, Walcott ND, 58077 or email to info@ndna .org, by May 20th, 2014 . All resumes will be kept confidential . EOE

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Page 8 Prairie Rose May, June, July 2014

Appraised by: Sevil Aliyeva, KellyDeraas, and Morgan Johnson

Clinical Question:Do pregnant women who have elective labor

inductions at term (39-41 weeks) have an increased risk of unplanned cesarean sections compared to those who go into spontaneous labor?

Articles: Ehrenthal,D .B ., Jiang,X .,&Strobino, D .M .(2010) .

Labor induction and the risk of a cesarean delivery among nulliparous women at term . Obstetrics and gynecology, 116, (1), 35-42 .

Jonsson, M ., Cnattingius, S ., & Wikstrom, A . (2013) . Elective induction of labor and the risk of cesarean section in low-risk parous women: a cohort study . Acta Obstetricia Et Gynecologica Scandinavica, 92(2), 198-203 .

Tam, T ., Conte, M ., Schuler, H ., Malang, S ., & Roque, M . (2013) . Delivery outcomes in women undergoing elective labor induction at term . Archives of Gynecology and Obstetrics, 287, (3), 407-11 .

Synthesis of Evidence:All three studies were a level IV retrospective

cohort studies . Ehrenthal, Jiang, and Strobino, (2010) used a total of 7804 women and labor induction was used in 43 .6% of women . Elective labor induction was the method/intervention used in 39 .9% of the women . The study was conducted over two years and seven months . Labor induction had increased the chances of unplanned cesarean sections by 20% . Jonsson, Cnattingius, and Wikstrom, (2013) conducted a study for parous women with no comorbidities or pregnancy complications . A total of 7973 women were used, and 343 women had elective labor induction . Out of the women who were electively induced, 52% failed to progress and had unplanned cesarean sections . Another complication was non-reassuring fetal heart rate which happened to 26% of electively induced women and lead to emergent cesarean sections . Elective inductions more than doubled the risk of unplanned cesarean sections . Tam, Conte, Schuler, Malang, and Rogue, (2013) conducted a study for low-risk women . A total of 848 pregnant women were included, with 694 of these women having a successful vaginal delivery and 154 having a caesarean delivery . Women who had a favorable cervical exam and multiparity had a greater chance of having a successful vaginal delivery . Studies showed a correlation between elective labor inductions and unplanned cesarean sections .

Bottom Line: (findings)The evidence suggests that elective labor

inductions increased the risk of unplanned cesarean sections .

Implications for Nursing Practice:Nurses should be aware of the risks of

elective labor inductions . The nurse educators and practitioners need to teach the staff about these risks and implement the teaching into the prenatal visits . Nurses and practitioners need to take the responsibility to inform the patient about the increased risks of cesarean sections due to elective inductions . Nurses need to be the advocate for the patient when the patient is not informed about the risks that go along with labor inductions . The nurses and practitioners have a duty to perform thorough assessments of the cervical condition and inform the patient if the cervix is not in favorable condition before discussing the option of labor induction . Nurses and practitioners should be aware of risk factors and co morbidities that can increase the risk of unsuccessful elective induction before they consider this option .

Appraised by: Nicole Andrews, Kari Haegele, and Jaclin Churchill

Clinical Question: In hospitalized patients, does nurse-to-nurse

handoff increase patient satisfaction and safety?

Articles: Jeffs, L ., Acott, A ., Simpson, E ., Campbell, H ., Irwin, T .,

Lo, J ., & . . . Cardoso, R . (2013) . The value of bedside shift reporting . Journal Of Nursing Care Quality, 28(3), 226-232 . doi:10 .1097/NCQ .0b013e3182852f46

Maxon, P .M ., Derby, K .M ., Wrobleski, D .M ., & Foss, D .M . (2012) . Bedside nurse-to-nurse handoff promotes patient safety . MEDSURG Nursing, 21(3), 140-145 .

Tidwell, T ., Edwards, J ., Snider, E ., Lindsey, C ., Reed, A ., Scroggins, I ., & . . . Brigane, J . (2011) . A nursing pilot study on bedside reporting to promote best practice and patient/family-centered care . Journal Of Neuroscience Nursing, 43(4), E1-5 . doi:10 .1097/JNN .0b013e3182212a1d

Synthesis of evidence:Among the three studies, nurse-to-nurse

bedside handoff has increased patient safety, satisfaction and nursing satisfaction . The study by Jeffs et al . (2013) is a phenomenological qualitative study, a level VI hierarchy of evidence . Tidwell et al . (2011) is a quasi-experimental study, a level III hierarchy of evidence . It was a convenience sample taken place in the Neuroscience Unit at Le Bonheur Children’s Medical Center . Maxon, Derby, Wrobleski, and Foss (2012) is a quasi-experimental study, conducted over one month following the practice of bedside handoff report . This study is a level III hierarchy of evidence . The overall quality of the studies is worthy, with consistent results indicating an increase in patient safety and satisfaction after the implementation of nurse-to-nurse bedside shift reporting . It is recommended to initiate a pilot program before nurse-to-nurse bedside shift handoff goes house-wide to avoid time is wasted . The pilot program gives the nurses the opportunity to create an organized and consistent etiquette to deliver patient handoff to the next nurse at shift change .

Bottom Line: (findings)The evidence suggests implementing bedside

reporting increases patient satisfaction and safety .

Nursing implication:Nurses can use this evidence to enhance the

technique of shift change when giving report to the nurse who will continue the plan of care of the patient . Nurse-to-nurse bedside handoff increases patient safety and satisfaction . The studies furthermore indicate financial savings, decreased report time, and increased nursing satisfaction .

Appraised by: Bridgette Bauer, Heather Berger,and Sarah Lorenz

Clinical Question: Does music therapy promote and increase

spiritual, emotional, and physical health in hospice patients who are at the end of life?

Articles: Bradt, J ., & Dileo, C . (2011) . Music therapy for end-of-

life care . The Cochrane Library, (3), 1-34 .Hilliard, R . E . (2003) . The effects of music therapy on

the quality and length of life of people diagnosed with terminal cancer . Journal of Music Therapy, XL (2), 113-137 .

Krout, R . E . (2001) . The effects of single-session music therapy interventions on the observed and self-reported levels of pain control, physical comfort, and relaxation of hospice patients . American Journal of Hospice & Palliative Care, 18 (6), 383-390 .

Synthesis of Evidence: The studies by Hilliard (2003), Krout (2001),

and Brandt and Dileo (2011) all had adequate sample sizes that allowed for the results to be statistically significant . All three studies indicated that more research needs to be done and specifically include a more diverse sample population and larger sample sizes . All three studies used tools to measure the patient’s emotional, physical, and spiritual health after music therapy visits . They provided good descriptions of the methods used and how the researchers utilized the appropriate methods to validate and analyze the data findings . The studies by Hilliard (2003) and Krout (2001) did indicate that music therapy helped to increase the patient’s emotional health whereas Brand and Dileo (2011) results were inconsistent and indicated that further research needs to be conducted .

Bottom Line: (findings)The evidence suggests that music therapy

does help to increase a patient’s emotional and spiritual health however has no impact on their overall physical health . The studies also suggest further research needs to be conducted on this subject .

Implications for Nursing Practice: Music therapy is an alternative form of

therapy that nurses can include in caring for hospice patients who are at the end of life . Nurses can assess all patients upon admission to see who would benefit from music therapy and who would be interested in the service . Informational cards indicating that music therapy is an available option can be placed at the patient bedside so they are aware of the program . The nurse can perform music therapy with the patient by means of recorded music or live instruments and reach out to music therapist or volunteers to assist . Patients can also be educated about the potential benefits from music therapy .

AlloftheEBPstudentabstractsonpages8-13weresubmittedbystudentsfromSanfordCollegeofNursinginBismarck,ND.ProfessorswereAnneEliason,MSN,RN,AssistantProfessor,TammyBuchholz,MSN,RN,AssociateProfessorand

WandaRose,PhD,RN,BCAssociateDean/AssociateProfessor.

SAVE THE DATE!September 17-18, 2014HIV/STD/TB/Hepatitis SymposiumRadisson Inn, Bismarck, ND Lunch and Learn Presentations are now being offered by the HIV/STD/TB/Hepatitis program.Visit us at www.ndhealth.gov/HIV/events.htm for more information! Continuing education credits are available for nurses.

The Department of Nursing, Minot State University, Minot, ND, invites applications for two nursing positions beginning August 2014.

Adult Health Nursing Faculty PositionPublic Health Nursing Faculty Position

Salary and rank commensurate with qualifications and experience. See qualifications, responsibilities, and

application procedures at http://www.minotstateu.edu/hr/jobs_02.shtml

May, June, July 2014 Prairie Rose Page 9

Appraised by: Regan Kono, Jessica Aluise, and Sam Farr

Clinical Question:Does stabilization of the healthy neonate,

delivered by cesarean section in the operating room with his/her mother lead to increased bonding and physiological well being versus removing the infant from his/her mother to stabilize in the nursery .

Articles:Gouchon, S ., Gregori, D ., Picotto, A ., Patrucco, G .,

Nangeroni, M ., & Giulio, P . D . (2010, March/April) . Skin-to-skin contact after cesarean delivery an experimental study . Nursing Research, 59(2), 78-84 .

Moore, E .R ., Anderson, G .C ., & Bergman, N . (2007) . Early skin-to-skin contact for mothers and their healthy newborn infants . Cochrane Database of Systematic Review . (3), CD003519 . Doi: 10 .1002/14651858 .CK003519 .pub2

Nolan, A ., & Lawrence, C . (2009) . A pilot study of a nursing intervention protocol to minimize maternal-infant separation after Cesarean birth . JOGNN: Journal Of Obstetric, Gynecologic & Neonatal Nursing, 38(4), 430-442 . Doi: 10 .111/j .15552-6909 .2009 .01039 .x .

Synthesis of Evidence:The articles by Gouchon, Gregori, Picotto,

Patrucco, Nangeroni, & Giulio (2010), Moore, Anderson, & Bergman (2007), as well as Nolan, & Lawrence (2009) all have scientific merit . The inclusions and exclusions for the population of each trial are clearly specified with the extraneous variables taken into account . The majority of the studies are randomized control trials, with one study in the systematic review from Moore, et . al (2007) being a quasi-randomized control trial . The inconsistencies were clearly explained in each of our articles . The findings of all of the studies were consistent in that there were no negative outcomes when skin to skin contact was practiced immediately after birth . The articles behold strong positive evidence addressing the issue of taking the baby away from the mother after delivery .

Bottom Line:The evidence supports positive physiological and

psychological impacts on the mother-infant dyad .

Implications for Nursing Practice:Nurses can educate the patients on the benefits

of skin-to-skin care along with the process of skin-to-skin care in the OR . This will improve patient satisfaction, allow the nurse to have a better rapport with the patients, as well as improve nurse-patient relationships .

Appraised by: Lexi Erickson, Meagan Schrader, and Nathan Voeller

Clinical Question:Does the use of therapeutic honey decrease the

wound healing time in topical wounds and ulcers?

Articles: Gethin, G ., & Cowman, S . (2009) . Manuka honey vs .

hydrogel – a prospective, open label, multicentre, randomised controlled trial to compare desloughing efficacy and healing outcomes in venous ulcers . Journal Of Clinical Nursing, 18(3), 466-474 . doi:10 .1111/j .1365-2702 .2008 .02558 .x

Malik, K ., Malik, M ., & Aslam, A . (2010) . Honey compared with silver sulphadiazine in the treatment of superficial partial-thickness burns . International Wound Journal, 7(5), 413-417 . doi:10 .1111/j .1742-481X .2010 .00717 .x

Robson, V ., Dodd, S ., & Thomas, S . (2009) . Standardized antibacterial honey (Medihoney) with standard therapy in wound care: randomized clinical trial . Journal of Advanced Nursing, 65(3) (3), 565-575 . http://dx .doi .org/10 .111/j .1365-2648 .2008 .04923 .x

Synthesis of Evidence:The results of all three studies show sufficient

evidence to consider change in our health care facilities, even though they were not statistically significant . There were no inconsistencies in the results of the three articles; they all showed a decrease in wound healing times . The data suggests that healing times after treatment of therapeutic honey are reduced as compared with conventional treatments (Robson et al ., 2009) . There is also evidence that the use of therapeutic honey reduces infection incidences in wound and ulcer healing (Cowman & Gethin, 2008) . Although not addressed in any of the three studies, it is possible that the reduction in healing time also had implications for reduction in treatment costs in regards to decreased consumables, patient stay, and nursing time (Robson et al ., 2008) . Overall, these benefits would improve quality of life of the patients being treated .

Bottom Line:There is enough evidence to show that our

health care providers, in the treatment of certain wounds and ulcers, should consider the use of therapeutic honey .

Implications for Nursing Practice:Nurses need to complete a very thorough

assessment and documentation in regards to healing time . We need to look at the size, depth, and characteristics of the wound/ulcer before, during, and after treatment . Time would be another crucial part of documentation .

Appraised by: Savannah Gaking, Georgia Hughes, and Traci Compaan

Clinical Question: D oes i mplement i ng noi se reduc t ion

interventions in acute patient care areas improve patient satisfaction?

Articles: Gardner, G ., Collins, C ., Osborne, S ., Henderson, A .,

& Eastwood, M . (2009) . Creating a therapeutic environment: A non-randomized controlled trial of a quiet time intervention for patients in acute care . International Journal of Nursing Studies, 46, 778-786 . http://dx .doi .org/10 .1016/j .ijnurstu .2008 .12 .009

Richardson, A ., Thompson, A ., Coghill, E ., Chambers, I ., & Turnock, C . (2009) . Development and implementation of a noise reduction intervention programme: A pre- and postaudit of three hospital wards . Journal of Clinical Nursing, 18, 3316-3324 . http://dx .doi .org/10 .1111/j .1365-2702 .2009 .02897 .x

Taylor-Ford, R ., Catlin, A ., LaPlante, M ., & Weinke, C . (2008) . Effect of a noise reduction program on a medical-surgical unit . Clinical Nursing Research, 17(2), 74-88 . http://dx .doi .org/10 .1177/1054773807312769

Synthesis of EvidenceAll three studies suggest a relationship between

implementing noise reduction interventions in acute care areas to improve patient satisfaction . The study done by Richardson et, al . (2009) did show a significant increase in patient satisfaction related to noise reducing interventions . The studies by Taylor-Ford et, al . (2008) and Gardner et, al . (2009) did not have significant findings but did conclude that patient satisfaction did increase when using noise reducing interventions . A limit to these studies causing a non-significant finding was an insufficient sample size . These studies also suggest using multiple interventions for noise reduction has a greater effect on patient satisfaction scores .

Bottom Line: (findings)The evidence suggests implementing noise

reduction interventions in acute patient care areas improves patient satisfaction .

Implications for Nursing Practice:Nurse can utilize interventions such as offering

earplugs, responding to medical devices promptly, initiating a set quiet time, and using noise meters to alert staff to excessive noise levels to decrease noise and improve patient satisfaction . Staff education can also be used as an important way to implement these interventions in acute care areas .

Maternal Infant and Early Childhood Home Visitation programs have been shown to prevent

child maltreatment by up to 50%. PCAND can help locate existing home visitation services around the state and connect existing programs to additional local and statewide resources.For more information and to get involved in any of this work, please contact Allison Mahoney, Home Visitation Program Manager 223-9052 or allisonm@pcand.org.

For information on upcoming trainings or to schedule a training for your group, contact:

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Page 10 Prairie Rose May, June, July 2014

Appraised by: Avery Henke and Dawn Weil

Clinical Question:Does the use of Acetaminophen in infants (0-

12 months) increase the prevalence of asthma in children (0-12 years)?

Articles: Beasley, R ., Clayton, T ., Crane, J ., Mutius, E .

V ., Lai, C . K ., Montefort, S ., & Stewart, A . (2008) . Association between paracetamol use in infancy and childhood, and risk of asthma, rhinoconjunctivitis, and eczema in children aged 6-7 years: analysis from phase three of the ISAAC programme . Lancet, 372, 1039-48 . Retrieved, from www .thelancet .com

Etminan, M ., Sadatsafavi, M ., Jafari, S ., Doyle-Waters, M ., Aminzadeh, K ., & FitzGerald, M . (2009) . Acetaminophen use and the risk of asthma in children and adults . Chest, 136(5), 1316-1323 . doi: 10 .1378/chest .09-0865 Retrieved from http://journal .publications .chestnet .org/article .aspx?articleid=1090147

Oshnouei, S ., Salarilak, S ., Khalkhali, A ., Karamyar, M ., Rahimi Rad, M ., & Delpishe, A . (2012, October 30) . Effects of acetaminophen consumption in asthmatic children . Iranian Red Crescent Medical Journal, 14(10), 641-646 . Retrieved from http://www .ncbi .nlm .nik .gov/pmc/articles/PMC3518981/

Synthesis of Evidence:The first study by Oshnouei, Salarilak,

Khalkhali, Karamyar, Rahimi, Delpishe (2012) and the results of this study were that Acetaminophen increased the risk of asthma among 2-8 year old children; however more studies need to be conducted to make evidence based guidelines to reduce acetaminophen consumption following post vaccination and other febrile disorders .

The second study by Beasley, Clayton, Crane, Mutius, Lai, Montefort, and Stewart(2008) and the results of this study found that the use of paracetamol in the first year of life and in later childhood is associated with the risk of asthma, rhinoconjunctivitis, and eczema . However, it suggests that further research be conducted to measure long-term effects of paracetamol to enable evidence-base guidelines for the recommended use in childhood to be made .

The last study by Etminana, Sadatsafavi, Siavash, Doyle-Waters, Aminzadeh, and FitzGerald (2009) and the findings from this review were that the risk of asthma in children among users of acetaminophen in the year prior to asthma diagnosis and within the first year of life was elevated . Only one study reported the association between high acetaminophen dose and asthma in children . There was an increase in the risk of asthma and wheezing with prenatal use of acetaminophen . In conclusion, the results are consistent with an increase in the risk of asthma and wheezing in both children and adults exposed to acetaminophen . Future studies are needed to confirm these results .

Each article looks at the association between the exposure of Acetaminophen and the risk of developing asthma . The conclusion of all three articles indicates that there is evidence of an increase in prevalence of asthma in childhood with the use of Acetaminophen however further research is needed to establish evidence based guidelines .

Bottom Line: (findings)The overall quality of the studies is good,

each study had sufficient sample sizes ranging from 600- 205,000 . The results were consistent indicating that further research is needed to establish an evidence based protocol however evidence is showing there is a correlation between acetaminophen use and asthma .

Implications for Nursing Practice:Further research is needed to measure

the long term effects of acetaminophen use in children for the risk of developing asthma in order to establish evidence based protocols for the recommended use of acetaminophen in childhood . Nurses should be aware of this evidence, and ask about family history of asthma as well as previous exposure to Acetaminophen before administering to children ages 0-12 . Although further research is needed and studies conducted, this issue is imperative in the clinical setting for the fact that Asthma is one of the most common chronic diseases in childhood . Therefore, we feel it is necessary to provide education to parents regarding the strong collaboration between acetaminophen use and the prevalence of asthma in children in attempt to implement prevention and protection amongst the pediatric population .

Appraised by: Kristina McCormick,Micah Munson and Ariel Mack

Clinical Question:In trauma patients, with suspected spinal

injuries, does spinal immobilization increase the risk of morbidity or mortality?

Articles:Abram, S ., & Bulstrode, C . (2010) . Routine spinal

immobilization in trauma patients: What are the advantages and disadvantages? The Surgeon, Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland , 8 (2010), 218-222 .

Haut, E . R ., Kalish, B . T ., Efron, D . T ., Haider, A ., Stevens, K . A ., Kieninger, A . N ., et al . (2010) . Spine immobilization in penetrating trauma; more harm than good? The Journal of Trauma; Injury, Infection, and Critical Care, 68 (1), 115-121 .

Stuke, L . E ., Pons, P . T ., Guy, J . S ., Chapleau, W . P ., Butler, F . K ., & McSwain, N . E . (2011) . Prehospital spinal immobilization for penetrating trauma-review and recommendations from the prehospital trauma life support executive committee . The Journal of Trauma: Injury, Infection and Critical Care, 71 (3), 763-770 .

Synthesis of Evidence:The overall quality of these studies is good .

Each study was consistent with their findings that spinal immobilization causes increased morbidity mortality . Both of the systematic reviews researched a sufficient amount of studies to report their findings . The study by Haut et . al . had a sufficient sample size of 45,284 . The studies have reasonable control over the methodology . Each of these articles show evidence that spinal immobilization is no longer the best practice for our patients . Each study showed similar reasons that spinal immobilization can harm patients including increased intracranial pressure, impeding endotracheal intubation, impairing respiratory function, inability to recognize other life threatening problems and many others . They all explained that spinal immobilization is a time consuming intervention when the best intervention is getting our patients to the hospital quickly . All the studies had similar recommendations suggesting that spinal immobilization can increase morbidity and mortality .

Bottom Line:The evidence suggests the use of spinal

immobilization increases morbidity and mortality rates in trauma patients . Therefore, we suggest a Selective Spinal Immobilization Protocol .

Implications for Nursing Practice:For nursing these studies are significant

in any trauma situation . The nurse can be an advocate for establishing a more selective protocol for spinal immobilization by educating other people about the risks of spinal immobilization and helping to decrease the time a patient is immobilized . Prompt care and accurate assessment skills are necessary in improving mortality rates in trauma patients . This includes the prompt removal of spinal immobilization and knowing when it is appropriate to immobilization the patient . There are appropriate times to apply spinal immobilization and it is important to know when . We recommend that spinal immobilization should not be applied based on mechanism of injury and a Selective Spinal Immobilization Protocol should be developed . The protocol should state which signs or symptoms warrant the intervention of spinal immobilization . This protocol should include altered mental status, evidence of intoxication, neurologic defect, suspected extremity fracture and spine pain or tenderness .

We would like to thank our nurses for their dedicated services this year during National Nurses Week!Visit us online for current employment opportunities!

150 County Rd 34, Arthur, ND 58006To learn more or apply please call Jan Timmermanat (701) 967-8316 or visit www.good-sam.com.

EOE, Drug-Free Workplace. All faiths or beliefs are welcome. 11-G0792

I t’s more than a job, its a calling.

The Fargo VA Health Care System has job opportunities for RNs and LPNs that seek a position in a challenging and cutting edge organization, delivering care to America’s veterans.

We are a general medical, surgical, and psychiatric facility with a restorative care unit and several clinics in Fargo and Community Based Outpatient Clinics throughout North Dakota. The Fargo VA Health Care System has state of the art electronic patient medical records and telehealth services.

We offer an excellent benefits package and salary commensurate with experience. Job openings can be viewed on the USAJOBS website, www.usajobs.gov.

VAHealthCareSystemHuman Resources (05)

2101 N. Elm Street, Fargo, ND 58102Phone: (701) 239-3700, Ext. 93641AnEqualOpportunityEmployer

Keeping the Promise

to those Who Served

May, June, July 2014 Prairie Rose Page 11

Appraised by: Bridget Hineman, Paige Voltz, and Tiffany Stoltz

Clinical Question:Does the use of massage in premature and low

birth weight infants (0 days to discharge) promote weight gain?

Articles: Kumar, J ., Upadhyay, a ., Dwivedi, A ., Gothwal, S .,

Jaiswal, V ., & Aggarwal, S . (2013) . Effect of oil massage on growth in preterm neonates less than 1800 g: a randomized control trial . Indian Journal of Pediatrics, 80(6), 465-469 . Doi:10 .1007/s12098-012-0869-7

Massaro, A ., Hammad, T ., Jazzo, B ., & Aly, H . (2009) . Massage with kinesthetic stimulation improves weight gain in preterm infants . Journal Of Perinatology, 29(5), 352-357 . doi:10 .1038/jp .2008 .230

Vickers, A ., Ohlsson, A ., Lacy, J ., & Horsley, A . (2004) . Massage for promoting growth and development of preterm and/or low birth-weight infants . Cochrane Database of Systematic Reviews, (2) DOI: 10 .1002/14651858 .CD000390 .pub2

Synthesis of Evidence: Kumar et . al . (2013) was a random control trial

testing whether oil massage on premature and low birth-weight infants promotes weight gain . Massaro et . al ., (2009) is a randomized control trail testing whether kinesthetic stimulation combined with massage will promote growth . Infants with kinesthetic stimulation gained an average of 0 .67 g/kg/day . Vickers et . al (2004) is a systematic review that consisted of 14 studies . These studies all suggested that massage was effective in promoting weight . All three studies provided a good description of the methods used and the researchers used appropriate statistical measures to analyze their data . All three studies suggest a relationship between massage on premature or low birth-weight infants and weight gain .

Bottom Line: (findings)The evidence suggests that premature infants

receiving massage will gain weight faster than those without the massage .

Implications for Nursing Practice:Nurses should frequently massage and

encourage parents to massage their premature or low birth weight infant to promote weight gain . Massage is a non-invasive and inexpensive nursing intervention . Nurses are encouraged to use massage as part of their holistic caring for these newborns .

Appraised by: Kadra Kalamaha, Jessica Leingang, and Courtney Landers

Clinical Question:In the Emergency Department, does family

presence during adult resuscitation increase family satisfaction?

Articles: Doolin, C ., Quinn, L ., Byrant, L ., Lyons, A ., & Kleinpell,

R . (2011) . Family presence during cardiopulmonary resuscitation: using evidence-based knowledge to guide the advanced practice nurse in developing formal policy and practice guidelines . Journal of The American Academy of Nurse Practitioners, 23 (1), 8-14 . Retrieved from EBSCOhost .

Halm, M . (2005) . Family presence during resuscitation: a critical review of the literature . American Journal Of Critical Care, 14(6), 494-512 . Retrieved from EBSCOhost .

Leske, J .S ., McAndrew, N .S ., & Brasel, K .J . (2013) . Experiences of families when present during resuscitation in the emergency department after trauma . Journal of Trauma Nursing, 20 (2), 77-85 . Retrieved from EBSCOhost

Synthesis of Evidence:The study by Leske, McAndrew, & Brasel (2013)

is a descriptive qualitative design consisting of a sample size of 28 individuals, with a level VI hierarchy of evidence . The study by Halm (2005) is a systematic review comprised of 28 studies, with all but two being qualitative studies . The systematic review by Halm (2005) is a level V hierarchy of evidence . The third study by Doolin et . al . (2011) is a literature review of 38 qualitative articles, a level VII hierarchy of evidence . The research base overall has scientific merit . All three articles were published in a peer review journal and were unbiased . The data and findings were in depth and discussed in detail . Every article had some weaknesses when looking at the clinical question of whether or not family satisfaction increases if present during adult resuscitation . The consistent findings among all three articles is that family members should be allowed the option of being present during resuscitation in the emergency department, helped know everything was done for the patient, helped them emotionally, and a written policy should be implemented . The sample sizes were adequate with 24 to 200 family members being present and no accumulative inconsistencies among the three articles could be identified . There is sufficient evidence by the three articles to make the recommendation that family members should be allowed or at least offered to be present during resuscitation in the emergency department .

Bottom Line: (findings)The evidence suggests that family presence

during resuscitation does increase satisfaction for both the family and the patient .

Implications for Nursing Practice:The hospitals should write up a clear formal

multidisciplinary policy addressing family presence during resuscitation, and family members should be allowed the option to be present in the emergency department .

Appraised by: Jill Mostad, Sarah Koch, and Mohamed Jalloh

Clinical Question:Does ECT manage/decrease depression in

pregnant women with no major side effects?

Articles: Bhatia, S .C ., Baldwin, S .A ., & Bhatia, S .K . (1999) .

Electroconvulsive therapy during the third trimester of pregnancy . The Journal of ECT, 15(4), 270-274 . Retrieved from EBSCOhost .

Bulbul, F ., Copoglu, U . S ., Alpak, G ., Unal, A ., Demir, B ., Tastan, M . F ., & Savas, H . A . (2013) . Electroconvulsive therapy in pregnant patients . General Hospital Psychiatry, http://dx .doi .org/10 .1016/j .genhosppsych .2013 .06 .008

Miller, L . J . (1994) . Use of Electroconvulsive therapy during pregnancy . Hospital and Community Psychiatry, 45(5), 444-450 .

Synthesis of Evidence:The study by Bhatia, Baldwin and Bhatia

(1999) is a small descriptive case study which looks at only two different women . Bhatia (1999) concluded that ECT was an effective treatment for both patients . Bulbul F ., Et al, (2013) is a retrospective cohort study of 33 patients . In their study 91 .6% of the patients with manic, depressive and mixed bipolar episode gained the full benefits of ECT . Which indicate that the application of ECT in every episode of patient with bipolar disorder could be efficient and reliable . The last study by Miller (1994) was a systematic review that looked at 300 cases involving ECT and pregnancy . According to Miller (1994) the use of ECT during pregnancy to treat major mood disorders is safe and effective if steps are taken to decrease potential risks .

The overall quality of the studies are good, with reasonably consistent results indicating that the administration of ECT during pregnancy to treat psychiatric disorder was found to be an effective treatment method with little side effects . One of the studies had small sample size which can make a difference in the quality of the study; however, the other two studies have sufficient sample size . The studies have similar recommendations suggesting Electroconvulsive therapy use in pregnancy for women who have psychiatric disorder is effective and has little side effects .

Bottom Line: (findings)ECT is a safe and effective treatment for

pregnant women with depression .

Implications for Nursing Practice:Nurses will be able to inform depressed

pregnant women about the option of ECT treatment when appropriate because the studies and existing literature show the ECT is a safe and effective treatment method for depression .

New Town, North Dakota Open Position

RN and Dialysis Technician for Tribal Dialysis Clinic

Qualifications:• Isaregisterednurse(BSNorADN)withaNorthDakotaLicenseas

definedintheNorthDakotaHealthGuidelinesandhasatleastoneyearnursingexperience.BLSandACLSrequired.

• DialysisTechnicianmustbecertifiedinNorthDakotaaccordingtoNDBONguidelines.BLSrequired.

Contact Lavetta Fox, KDU AdministratorTAT-Kidney Dialysis Center 1-701-627-4840

lavettafox@mhanation.com

Three Affiliated Tribes

MHA NationMandan, Hidatsa & Arikara Nation

Northwood Deaconess Health CenterWe would like to extend a Very Special “Thank You”

to all of our dedicated and caring Nurses atNorthwood Deaconess Health Center.

Interested in employment? Contact:

Nancy Carlson, RN/DONat 701-587-6487 or

nancy.carlson@ndhc.net

www.ndhc.net

located on the North Dakota and Manitoba border at the International Peace Garden

International Music CampInternational Music Camp

For more info, contact us at 701.838.8472or info@internationalmusiccamp.comChristine Baumann and Tim Baumann,

Camp Directors

Camp Nurse needed for one-week sessions in June and July

Work while your child attends IMC!Ask about our tuition exchange program

Director of Nursing and RN/LPN/CNA positions available

GCCC offers competitive wages, excellent benefits, shift differentials, student loan reimbursement & more!

View GCCC’s numerous employment opportunities on our website, www.coopermc.com

Contact rhodaj@coopermc.com or (701) 797-2221.

New Grads welcome!

EOE

Page 12 Prairie Rose May, June, July 2014

Appraised by: Deeqa Omar, Tamsen O’Berry,and Heather Jesme

Clinical Question:Does providing cultural competence training to

nurses improve their ability to deliver culturally competent care?

Articles: Beach, C . M ., Price, G . E, Gary, L . K ., Robinson, K . A .,

Gozu, A ., Palacio, A ., …Cooper, L . A . (2005) . Cultural competence: A systematic review of health care provider education interventions . Medical Care, 43(4), 356-373 .

Delgado, D . A ., Ness, S ., Ferguson, K ., Engstrom, P . L ., Gannon, T . M ., & Gillett, C . (2013) . Cultural competence training for clinical staff: Measuring the effect of a one-hour class on cultural competence . Journal of Transcultural Nursing, 24(2), 204-213 . doi:10 .1177/1043659612472059

Smith, L .S . (2001) . Evaluation of an educational intervention to increase cultural competence among registered nurses . Journal of Cultural Diversity, 8(2): 50-63 .

Synthesis of Evidence:Beach et al . (2005) conducted a systematic

review on provider knowledge, attitude, skills, and patient satisfaction before and after cultural competency training . The review indicated excellent evidence that cultural competency training improves knowledge, attitude, and skills of providers, but there was poor evidence that training impacts patient adherence and outcomes . Delgado et al . (2013) was a quasi-experimental study that assessed the effect of a one-hour class on cultural competence by comparing the baseline scores to post intervention scores three and six months after completion of the class . Scores were divided levels of culturally incompetent, culturally aware, culturally competent, and culturally proficient . The overall increase in mean scores demonstrates a statistically significant improvement in cultural awareness, even when failing to reach the level of competence . Smith (2001) conducted a quasi-experimental study where subjects were randomly assigned to attend either an eight hour “culture school” or an eight hour nursing informatics class . Subjects who attended “culture school” had a greater self-reported cultural self-efficacy and greater cultural knowledge when compared to the subjects who participated in the nursing informatics class . The study concluded that a cultural education intervention could significantly increase cultural competence as measured on cultural self-efficacy scales and knowledge based questions . All three studies used good research designs to answer the research question . The articles indicated positive outcomes on health provider knowledge, when cultural competency training is provided . Based on the three articles reviewed, educational interventions deliver results to increase cultural competency within nursing practice .

Bottom Line:Educational interventions, such as a cultural

competency training program, increase health providers’ knowledge, providing positive results to increase cultural competency within nursing practice .

Implications for Nursing Practice:Providing training to nursing staff may

increase their ability to provide better care to diverse populations . Evidence suggests a positive trend between training programs and improved outcomes, but more research is needed . An intervention that can be put into place would be mandating cultural competence training to all nurses to improve knowledge and skills needed to provide culturally sensitive and competent care .

Appraised by: Malorie Rupert, Haley Winkler, and Josh Swigart

Clinical Question:Is using symptom-triggered treatment

protocol more effective in treating patients with acute alcohol withdrawal than fixed schedule treatment?

Articles: Ng, K ., Dahri, K ., Chow, I ., Legal, M . (2011) .

Evaluation of an alcohol withdrawal protocol and a preprinted order set at a tertiary care hospital . California Journal of Health Promotion, 64 (6), 436-445 . Retrieved from PubMed .

Recuopero, P ., Stuart, G ., Bidadi, N ., Harms, S . (2010) . Effectiveness of a polysubstance dependence detoxification protocol for patients with co-occurring disorders . Journal of Dual Diagnosis, 6, 74-93 . Retrieved from EBSCOhost .

Saitz, R ., Smith ., Roberts, M ., Redmond, H ., & Calkins, D . (1994) . Individualized treatment for alcohol withdrawal: A randomized double-blind control study . JAMA, 272(7), 519-523 . Retrieved from http://ovidsp .tx .ovid .com/sp-3 .10 .0b/ovidweb .cgi

Synthesis of Evidence:Overall the quality of the studies are good,

with consistent results showing a relationship between the use of a symptom-triggered protocol for alcohol withdrawal and less incidence of severe complications from withdrawal and shorter stay in the hospital . The studies have good control over methodology . Limitations of all studies include a small sample size . Other limitations of Recuopero et al . (2010) include a narrow demographic population of predominantly Caucasian males, co-occuring disorders and severe impairments, and the use of antipsychotic medications that are thought to improve disturbed sleep, reduce cravings, and mask symptoms of withdrawal . Limitations of Ng et al . (2011) include a retrospective design from which the two groups were studied at different time periods . The post-protocol group that used a symptom-triggered protocol, also appeared to have a more severe addiction history . Another limitation to take into consideration is that hospital culture has changed to discharge patients earlier all the time . The protocol implementation is likely to have contributed to decreased hospital stay, improving patient outcomes, and reducing hospital costs . Lastly, limitations of Saitz et al . (1994) include no differences in major complications, however, it was not deigned to detect small differences in rates of uncommon complications . There was also a trend toward hallucinations, delirium tremens, and prior detoxification in the fixed-schedule group, though randomization was generally successful .

Bottom Line: (findings)A symptom triggered protocol is more effective

in treating patients a risk for or undergoing alcohol withdrawal evidenced by reduction in patient length of stay, amount of benzodiazepines administered, and severe adverse events .

Implications for Nursing Practice:Healthcare workers can use this evidence

to support developing a symptom-triggered protocol for alcohol withdrawal in their facility . The evidence shows there will be a shorter stay, less medication administration, and fewer complications, which would ultimately reduce hospital expenses . Also nurses can advocate for their patients by using the protocol to reduce the chances of complications from withdrawal .

Appraised by: Elizabeth Sam, Samira Roble, and Alexis Griffin

Clinical Question:For chronically ill patients over the age 65

years and older, does the use of telehealth reduce hospital readmission rates?

Articles: McManus, S . G .(2004) . A telehealth program to reduce

readmission rates among heart failure patients: one agency’s experience . Home Health Care Management & Practice, 16(4), 250-254 . http://dx .doi .org/10 .1177/1084822303262542

Riegel, B ., Carlson, B ., Kopp, Z ., LePeti, B ., Glaser, D ., & Unger, A . (2002) . Effect of a standardized nursing case-management telephone intervention on resource use in patients with chronic heart failure . Archives of Internal Medicine, 162,(6), 705-712 . Retrieved from http://ovidsp .ovid .com/ovidweb .cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&AN=00000779-200203250-00013&LSLINK=80&D=ovft

Sorknaes, A . D ., Madsen, H ., Hallas, J ., Jest, P ., & Hansen-Nord, M . (2010) . Nurse tele-consultations with discharged COPD patients reduce early readmissions - an interventional study . The Clinical Respiratory Journal, 26-34 . http://dx .doi .org/10 .1111/j .752-699X .2010 .00187 .X

Synthesis of Evidence:Reigel, et al . (2002) and Sorkneas, et al .

(2010) had large sample sizes which allowed for statistically significant results . McMannus (2004) was a small sample size group, but also provided significant results supporting the use of telehealth . All three articles supported the use of telehealth and showed a decrease in readmission rates within 30 days to the hospital after initial discharge with a chronic disease (COPD, cancer, CHF) . Satisfaction of the telehealth program use was high in the intervention groups and healthcare providers of all three articles . All three articles provided a good description of telehealth, its functions and how it was integrated into home health services . Further research is suggested in the use of telehealth in different populations, larger randomized patient sample sizes and non-randomized physician participation .

Bottom Line: (findings)The evidence suggests the use of telehealth

services can decrease readmission rates to the hospital for chronically ill patients over the age of 65 years .

Implications for Nursing Practice:Nurses can provide real-time interventions

to patients based on vital signs and symptom management . If using telehealth as an extension of home health services, patients have the ability to work with their medical providers using telephonic or video communication on a daily basis . Based on the patient’s symptoms, the nurse can provide early interventions by using her critical thinking and case management skills .

Mountrail County Health Center provides quality health care to the Stanley community and surrounding area of NW North Dakota.

CURRENT OPENINGSDirector of Nursing

PHYSICAL THERAPISTRN * LPN * CNA

ACTIVITY AIDE * LAUNDRY AIDEDIETARY AIDE * COOK

HOUSEKEEPING * LAUNDRY * RESIDENT HELPERQA * INFECTION CONTROL

FULL & PART-TIME POSITIONSCOMPETITIVE SALARYEXCELLENT BENEFITS

APPLY ONLINEwww.stanleyhealth.org

For more information contact

Human Resources at 701-628-2442

or send resume to:

hrdirector@stanleyhealth.org

Equal Opportunity Employer

MOUNTRAIL COUNTY HEALTH CENTER• 57-bed Skilled Nursing Home

• 11-bed Critical Access Hospital• Rural Health Clinic

• Emergency Medical Care• Swing Bed

• Senior Apartments

May, June, July 2014 Prairie Rose Page 13

Appraised by: Sarah Schlepp, Hollie Toepke, and Amanda Kuller

Clinical Question: In oncology patients, does massage therapy help

promote comfort and decrease pain?

Articles:Currin, J ., & Meister, E . A . (2008) . A hospital-based

intervention using massage to reduce distress among oncology patients . Cancer Nursing, 31(3), 214-221 .

Sui-Whi, J ., et al (2001) . Effects of massage on pain, mood status, relaxation, and sleep in taiwanese patients with metastatic bone pain: A randomized clinical trial . Pain, 152(10), 2432-42 .

Toth, M . (2013) . Massage therapy for patients with metastatic cancer: A pilot randomized controlled trial . The Journal of Alternative and Complementary Medicine, 19(7), 650-56 .

Synthesis of Evidence:All three studies had consistent findings, which

included reduced pain and increased quality of life, which adds to the scientific merit of the research . Each study focuses on the effects of massage on pain and quality of life in oncology patients and therefore addresses the PICO question . The findings provide sufficient evidence to make a change in practice .

Bottom Line: (findings)Evidence suggested by the studies reviewed

showed that with the implementation of massage therapy, pain was decreased and comfort was increased in oncology patients .

Implications for Nursing:The implication for nursing is that it is the

nurses’ duty to assess and manage patient pain . Management of pain can include implementation and education about non-pharmacological methods, such as massage therapy, which can lead to improved clinical outcomes and improve patient and/or nurse satisfaction . A pilot project would be recommended as a valid method to implement the intervention, massage therapy, into the care routine of oncology patients .

Appraised by: Nicole Schroeder, Amber Markel, and Krystle Cremer

Clinical Question:Does the use of a fall prevention program with

an intervention reduce the risk of falls in patients over the age of 60 in acute care settings?

Articles:Cumming, R ., Sherrington, C ., Lord, S ., Simpson,

J ., Vogler, C .,  Naganathan, V ., et al . (2008) Cluster randomised trial of targeted mulifactorial intervention to prevent falls among older people in hospital . BMJ, 336, 758-760 . Doi:10 .1136/bmj .39499 .546030 .BE

Schorr, R . I ., Chandler, M ., Mion, L ., Waters, T . M ., Liu, M ., Daniels, M . J ., et al . (2012) . Effects of an Intervention to increase bed alarm use to prevent falls in hospitalized patients . American College of Physicians, 157(10), 692-699 .

Williams, T . A ., King, G ., Hill, A ., Rajagopal, M ., Barnes, T ., Basu, A ., Pascoe, G ., Birkett, K ., Kidd, H ., (2007) . Evaluation of a falls prevention programme in an acute tertiary care hospital . Journal Of Clinical Nursing, 16(2), 316-324 . doi:10 .1111/j .1365-2702 .2005 .01410 .x

Synthesis of Evidence:The evidence has scientific merit because

in each study control groups were used, and conclusions were made at the end of the study . In all of the studies the objective was to decrease patient falls in an acute care setting . Each study used multiple units and was three months or longer . Data was collected and documented by registered nurses in each trial .

In the study done by Williams et al ., (2007) there was no randomization . The nurses did not implement the interventions consistently . Data collection was not consistent . However, the sample size was large enough to detect a reduction in falls . In the study done by Shorr et al, (2012) the sample size was not large enough to detect a decrease in falls and the study was conducted at a single site . In the study done by Cumming et al ., (2008) nursing staff was aware of the study and on which units it was being conducted . The data collected did not show a significant difference in fall rates .

The study done by Williams et al ., was the only research that showed reduced fall rates using multiple interventions .  The other research did not show a reduction in fall rates, but stated more research and approaches need to be conducted .

Bottom Line: (findings)The evidence suggests using a fall prevention

program with the use of interventions will decrease falls . However, more research conducted to show which interventions are most effective .

Implications for Nursing Practice:Nurses need to be educated and also be active

educators to patients and patient’s families about fall prevention interventions .

Appraised by: Kristie Zachmeier, Hailey House, and Kim Pazdernik

Clinical Question:Does administering sucrose solution to infants

(1-12 months) experiencing needle related procedures reduce infant pain?

Articles: Curry, D ., Brown, C ., & Wrona, S . (2012) .

Effectiveness of oral sucrose for pain management in infants during immunizations . Pain Management Nursing, 13 (3), 139-149 . doi: 10 .1016/j .pmn .2010 .07 .008

Kassab, M ., Foster, JP ., Foureur, M ., & Fowler, C . (2013) . Sweet-tasting solutions for needle-related procedural pain in infants one month to one year of age . The Cochrane Collaboration, 2, 1-59 . doi: 10 .1002/14651858 .CD008411 .pub2 .

McCall, J ., DeCristofaro, C ., & Elliott, L . (2013) . Oral sucrose for pain control in nonneonate infants during minor painful procedures . Journal of the American Association of Nurse Practitioners, 25, 244-252 . doi: 10 .1111/j .1745-7599 .2012 .00783 .x

Synthesis of Conclusions:Currently there is insufficient evidence

supporting the use of sucrose to reduce pain in infants (1-12 months) experiencing needle-related procedures . We suggest implementing a pilot study on the Pediatric unit, NICU, and Emergency Department .

Bottom Line: (findings)There is not sufficient evidence to fully

support the use of sucrose for needle-related procedures to decrease pain in infants (1-12 months) .

Implications for Nursing Practice:In order to implement this pilot study we

would use Unit Based Council Meetings (UBC’s) and SanfordLearn to the units effected . The pilot study would take place over a three-month period . The first month a data collection form would be implemented . This form would evaluate: what form of pain management was utilized, what time it was administered, and NIPS score before and after administration . The following two months we would implement the intervention of administering sucrose to reduce infant (1-12 months) pain . This data will be gathered by utilizing a separate form . This form would include: what time sucrose was administered, the amount administered, and NIPS score before and after administration . A copy of the form would be filed in a separate folder . Every month these forms will be gathered and the information will be processed . Determining whether sucrose is a means of effectively reducing pain is the expected outcome . If proven effective, SanfordLearn education module should be completed annually by staff using this procedure .

Hill Top Home of Comfort

“The Home With Heart”

Ready for a change, tremendous opportunities, a caring and compassionate environment?

Consider Hill Top Home!Now Hiring LPN’s and RN’sCompetitive Wages (DOE)

To apply visit http://www.hthc.org/employment.html for employment application.

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Any questions call Ann Hedger, DON 701-764-5682. EOE

Upper Missouri District Health Unit

Registered Public Health Nurse

The Upper Missouri District Health Unit is looking for an energetic dynamic person for our Registered Public Health Nurse. This is a permanent full-time position working in our Williston office. Wage range $22.27 – $27.84, fully paid family health insurance, primarily 8am to 5pm, M-F, and with paid holidays. Come be a part of an exciting team at an exciting time. See Job Service to apply.

Page 14 Prairie Rose May, June, July 2014

Appraised by: Whitney Buchholz SN, Morgan Ihmels SN and Ashley Krieg SN

(Sanford College of Nursing, Bismarck, ND)

Clinical Question: Does the use of therapeutic hypothermia in

newborns with hypoxic ischemic encephalopathy reduce the risk of childhood disabilities?

Synthesis of Conclusions:Careful assessment of three research articles

concludes that evidence in all three studies reviewed meets design criteria and has scientific merit . The evidence in all articles addresses the issue of therapeutic hypothermia for term or near-term infants with hypoxic ischemic encephalopathy (HIE), which helped answer the question of whether the use of therapeutic hypothermia in newborns with hypoxic ischemic encephalopathy reduces the risk of childhood disabilities .

The first study by Jacobs, S ., Morley, C ., Inder, T ., Stewart, M ., Smith, K ., McNamara, P ., & …Doyle, L . (2011) is a multi-center, international, randomized control trial with a level 1 hierarchy of evidence . The purpose of the study was to determine the effectiveness and safety of moderate whole-body hypothermia in newborns with hypoxic-ischemic encephalopathy born in hospitals with and without newborn intensive care facilities or complicated hypothermia equipment . The study findings revealed that therapeutic hypothermia significantly reduced the risk of death or major sensorineural disability at 2 years of age with an

NeonatalTherapeuticHypothermiaforHypoxic-Ischemiaabsolute reduction of 15% . The authors concluded that whole-body hypothermia commenced at birth within 6 hours of birth is effective and appears safe in term and near-term newborns with HIE, reducing the risk of death or disability at 2 years of age .

The second study by Wu ., L ., Yi, B ., Hu, Y ., Ji, C ., Zhang, T . (2012) was a meta-analysis of 8 randomized control trials with a level 1 hierarchy of evidence . The methodological quality of the recruited studies was evaluated according to the guidelines of the neonatal review group of the Cochrane Collaboration . The purpose of the review was to evaluate the efficacy of hypothermia in the treatment of hypoxic-ischemic encephalopathy (HIE) in neonates at 18 months of age or more and to examine whether the severity of encephalopathy affects the efficacy of hypothermia on mortality and neurodevelopmental disability . The analysis showed that hypothermia reduced the combined rate of death or neurodevelopmental disability not only in moderate encephalopathy infants but also in severe encephalopathy infants . However, it is important to note that the analysis was available only from a subgroup of trials .

The third study by Zhou, W ., Cheng, G ., Shao, X ., Liu, X ., Shan, R ., Zhuang, D ., & . . . Wang, L . (2010) is a randomized control trial with a level 1 hierarchy of evidence . The purpose of the study was to investigate the efficacy and safety of selective head cooling with mild systemic hypothermia in hypoxic-ischemic encephalopathy (HIE) in newborn infants . One hundred ninety-four infants were available for analysis (100 and 94 infants in the selective head cooling and control group, respectively) . The study findings revealed that for the selective head cooling and control groups, respectively, the combined outcome of death and severe disability was 31% and 49%, the mortality rate was 20% and 29%, and the severe disability rate was 14% and 28% . The authors concluded that selective head cooling combined with mild systemic hypothermia for 72 hours may significantly decrease the combined outcome of severe disability and death, as well as severe disability .

The quality of each study was excellent, with all reaching similar conclusions . All three articles were strong and at a level 1 in the hierarchy

of evidence because they address relevant randomized controlled trials and a systematic review . The two high quality randomized controlled trials were consistent in the findings that therapeutic hypothermia is beneficial in mild and severe hypoxic ischemic encephalopathy (HIE) . The meta-analysis of eight high quality studies combining subgroups with a total sample size of 1,381 neonates also concluded that therapeutic hypothermia is beneficial treatment and should be implemented in the clinical setting . This sample size was sufficient and allowed for increased power .

Bottom Line:There is sufficient evidence to suggest that

whole-body hypothermia commenced at birth within 6 hrs of birth should be practiced because it is effective and appears safe in term and near-term newborns with HIE, reducing the risk of death or disability at 18 months to 2 yrs of age . The method of therapeutic hypothermia is uncomplicated, pragmatic, and inexpensive, and therefore it is widely applicable .

Implications for Nursing Practice: Nurses working in the neonatal intensive

care unit (NICU) in collaboration with Neonatal Nurse Practitioners (NNP), obstetric nurses and Neonatologists can use the evidence from these studies to support the implementation of therapeutic hypothermia in newborns that fit criteria as outlined in institutional policies and procedures . Although a number of hospitals in the region have implemented therapeutic hypothermia as a standard of care for infants suffering from HIE, many hospitals have yet to do so . Nurses working with newborns should be key players in bringing about this practice change and implementation of therapeutic hypothermia use for newborns fitting criteria in hospitals that have yet to do so .

Articles: Jacobs, S ., Morley, C ., Inder, T ., Stewart, M ., Smith,

K ., McNamara, P ., & . . . Doyle, L . (2011) . Whole-body hypothermia for term and near-term newborns with hypoxic-ischemic encephalopathy: a randomized controlled trial . Archives Of Pediatrics & Adolescent Medicine, 165(8), 692-700 . doi:10 .1001/archpediatrics .2011 .43

Wu ., L ., Yi, B ., Hu, Y ., Ji, C ., Zhang, T . (2012) . The Efficacy of Hypothermia in Hypoxic-Ischemic Encephalopathy at 18 Mo or More . Indian Journal of Pediatrics, 79(10), 1342-1346 . DOI 10 .1007/s12098-011-0673-9

Zhour, W ., Cheng, G ., Shao, X ., Liu, X ., Shan, R ., Zhuang, D ., &…Wang, L . (2010) . Selective head cooling with mild systemic hypothermia after neonatal hypoxic-ischemic encephalopathy: a multicenter randomized controlled trial in China . Journal of Pediatrics, 157(3), 367 . Doi: 10 .1016/j .jpeds .2010 .03 .030

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May, June, July 2014 Prairie Rose Page 15

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Page 16 Prairie Rose May, June, July 2014