Publications by authors named "Karlen E Luthy"

42 Publications

Empowering nurse practitioners to make health policy CHANGE: Steps to successful passage of legislation in Utah.

J Am Assoc Nurse Pract 2021 Feb 4. Epub 2021 Feb 4.

College of Nursing, Brigham Young University, Provo, Utah.

Abstract: Nurse practitioners have the skills needed to make meaningful policy change to improve health care. In 2017, the authors championed a bill, House Bill 308 Substitution 2 (HB 308 Sub 2), which passed in the Utah Legislature. This health policy article details the process of successful passage of HB 308 Sub 2 and guides advanced practice registered nurses (APRNs) in enacting legislation. The steps detailed to enact legislation are based on Longest's policy framework (2006). The acronym CHANGE was developed and stands for collecting data, hinge, associations, negotiate, gather, and expect to be the expert. Intricacies of lawmaking are also explained including timing of legislation, the three readings, and lobbying. The CHANGE acronym outlines the following: Collecting data to legitimize the problem and proposed solution. The Hinge refers to the specifics of the proposed solution. Associations involve garnering support from key stakeholders early and often in the legislative process. Negotiate refers to finding a bill sponsor that is trustworthy, negotiates well, and has political capital. Gather public support is a critical step to increase legislatures' constituent communication requesting support for the bill. Expect to be the expert refers to understanding arguments for and against the bill and crafting power statements. Passing of HB 308 Sub 2, through the work of APRNs, provides a step-by-step guide to successful passing of legislation. This guide will empower APRNs across the nation with the knowledge to enact and pass policies to improve health care in our nation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/JXX.0000000000000561DOI Listing
February 2021

Knowledge, attitudes, and perceptions of nurse practitioners about antibiotic stewardship.

J Am Assoc Nurse Pract 2020 Jul 29. Epub 2020 Jul 29.

College of Nursing, Brigham Young University, Provo, Utah.

Background: Antibiotic stewardship (ABS) is a set of strategies to optimize antimicrobial use while reducing antibiotic resistance, improving patient outcomes, and decreasing unnecessary costs. Nurse practitioners (NPs) play an essential role in health care education and represent a valuable potential resource for ABS efforts.

Purpose: The purpose of this study was to describe the knowledge, attitudes, and perceptions of NPs toward ABS.

Methods: A convenience sample of NPs attending the American Association of Nurse Practitioners annual conference was given a modified descriptive survey. Descriptive statistics were used to assess normality.

Results: A total of 194 NPs completed the questionnaire (88% female; 70% master's degree). Factors affecting the decisions of antibiotic prescriptions included patient condition (79%) and patient cost (58%). Nurse practitioners based their antibiotic decisions on the antibiogram (63%) in their setting, whereas 56% indicated they start with broad spectrum and tailor antibiotic choices after cultures are received. Nurse practitioners understood that inappropriate antibiotic use causes resistance (97%), harms the patient (97%), and optimum antibiotic use will reduce resistance (94%). Participants also recognized that strong knowledge of antibiotics was important (94%) and felt confident in using antibiotics (86%). However, 94% agreed that antibiotics are overused nationally, and only 62% thought antibiotics were overused in their setting.

Implications For Practice: Nurse practitioners recognize that knowledge about antibiotics is important to their career and would like more education about antibiotics and feedback about their antibiotic choices. Finding effective ways to provide this education could change practice and improve antibiotic use.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/JXX.0000000000000467DOI Listing
July 2020

Family Behaviors as Unchanging Obstacles in End-of-Life Care: 16-Year Comparative Data.

Am J Crit Care 2020 07;29(4):e81-e91

About the Authors: Renea L. Beckstrand and Karlen E. Luthy are professors and Janelle L. B. Macintosh is an associate professor at Brigham Young University College of Nursing, Provo, Utah.

Background: Critical care nurses routinely care for dying patients. Research on obstacles in providing end-of-life care has been conducted for more than 20 years, but change in such obstacles over time has not been examined.

Objective: To determine whether the magnitude scores of obstacles and helpful behaviors regarding end-of-life care have changed over time.

Methods: In this cross-sectional survey study, questionnaires were sent to 2000 randomly selected members of the American Association of Critical-Care Nurses. Obstacle and helpful behavior items were analyzed using mean magnitude scores. Current data were compared with data gathered in 1999.

Results: Of the 2000 questionnaires mailed, 509 usable responses were received. Six obstacle magnitude scores increased significantly over time, of which 4 were related to family issues (not accepting the poor prognosis, intrafamily fighting, overriding the patient's end-of-life wishes, and not understanding the meaning of the term lifesaving measures). Two were related to nurse issues. Seven obstacles decreased in magnitude, including poor design of units, overly restrictive visiting hours, and physicians avoiding conversations with families. Four helpful behavior magnitude scores increased significantly over time, including physician agreement on patient care and family access to the patient. Three helpful behavior items decreased in magnitude, including intensive care unit design.

Conclusions: The same end-of-life care obstacles that were reported in 1999 are still present. Obstacles related to family behaviors increased significantly, whereas obstacles related to intensive care unit environment or physician behaviors decreased significantly. These results indicate a need for better end-of-life education for families and health care providers.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4037/ajcc2020661DOI Listing
July 2020

Educating Patients About Opioid Disposal: A Key Role for Perianesthesia Nurses.

J Perianesth Nurs 2019 Oct 17;34(5):1025-1031. Epub 2019 Mar 17.

Purpose: To examine opioid prescription practices, patient use of opioids after laparoscopic cholecystectomy, and patient knowledge about disposal of unused medication.

Design: Mixed methods design with a chart review and structured phone interview.

Methods: Thirty-four patients were interviewed by phone and asked how many opioids were prescribed, how many excess pills they had 6 to 10 days postoperatively, and if they knew how to dispose of them.

Findings: Average number of excess pills ranged from 0 to 42 (mean = 14; SD = 11.7). Nearly half of patients (47%) perceived the prescribed quantity as "too many." Seventy-one percent of patients using opioids for 5 days or less and 88% did not recall any instruction about medication disposal.

Conclusions: Patients often have excess prescribed opioids after laparoscopic cholecystectomy, and they do not understand proper disposal of unused medications. Education about proper disposal of unused opioids medications is a key role of perianesthesia.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jopan.2018.12.008DOI Listing
October 2019

Adult Vaccination Rates in the Mentally Ill Population: An Outpatient Improvement Project.

J Am Psychiatr Nurses Assoc 2020 Mar/Apr;26(2):172-180. Epub 2019 Mar 13.

Lacey Eden, MS, FNP, Brigham Young University, Provo, UT, USA.

Adults who suffer with severe and persistent mental illness (SPMI) rarely access medical care to receive preventive vaccines. To increase the rate of vaccines among the SPMI population in an outpatient community mental health center (CMHC). A review of the literature identified a gap between the general population and SPMI clients in receiving preventive vaccinations. An initial mixed-method convenience survey of SPMI clients ( = 392) provided information on current vaccination status, demographics, beliefs, and interest in receiving vaccines. A vaccination program was developed to address identified barriers and increase vaccination rates. Postintervention data were collected through a mixed-method convenience survey of SPMI clients ( = 60) who participated in immunizations clinics to evaluate client satisfaction. A partnership between the health department and CMHC was developed to deliver vaccines in a nontraditional site. Vaccines administered included annual influenza; hepatitis A; hepatitis B; herpes zoster; measles, mumps, and rubella; pneumococcal; and tetanus, diphtheria, and pertussis (Tdap). More than 1,000 vaccines were administered in the first 8 months, with a significant increase in vaccination rates over baseline for individual vaccines ranging from 18.75% to 83%. Postintervention survey results found a 95% satisfaction rate. Implementation of a vaccination program in a nontraditional site that facilitates access for SPMI clients can promote an overwhelming increase in the vaccination rates for this underserved population. Results suggest that the integration of mental health and CMHC services can have a profound positive effect on SPMI population health.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1078390319831763DOI Listing
March 2019

Critical Care Nurses' Qualitative Reports of Experiences With Family Behaviors as Obstacles in End-of-Life Care.

Dimens Crit Care Nurs 2018 Sep/Oct;37(5):251-258

Renea L. Beckstrand, PhD, RN, CCRN, CNE, is professor, Brigham Young University College of Nursing, Provo, UT. Caitlin Mallory, BS, RN, is graduate student, NSTICU, Utah Valley Hospital, Provo. Janelle L. B. Macintosh, PhD, RN, is associate professor, Brigham Young University College of Nursing, Provo, Utah. Karlen E. Luthy, DNP, FNP-c, FAAN, is associate professor, Brigham Young University College of Nursing, Provo, Utah.

Background: Critical care nurses (CCNs) frequently provide end-of-life (EOL) care for critically ill patients. Critical care nurses may face many obstacles while trying to provide quality EOL care. Some research focusing on obstacles CCNs face while trying to provide quality EOL care has been published; however, research focusing on family behavior obstacles is limited. Research focusing on family behavior as an EOL care obstacle may provide additional insight and improvement in care.

Objectives: We wanted to gather firsthand experiences of CCNs regarding working with families of dying patients. We then wanted to determine the predominant obstacle themes noted when CCNs share these rich experiences in EOL care.

Methods: A random geographically dispersed sample of 2000 members of the American Association of Critical-Care Nurses was surveyed. Responses from a qualitative question on the questionnaire were analyzed.

Results: Sixty-seven EOL obstacle experiences surrounding issues with families' behavior were analyzed for this study. Experiences were categorized into 8 themes. Top 3 common obstacle experiences included families in denial, families going against patient wishes and advanced directives, and families directing care that negatively impacted patients.

Conclusions: In overcoming EOL obstacles, it may be beneficial to have proactive family meetings to align treatment goals and to involve palliative care earlier in the ICU stay.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/DCC.0000000000000310DOI Listing
January 2019

Emergency Nurses' Department Design Recommendations for Improved End-of-Life Care.

J Emerg Nurs 2019 May 13;45(3):286-294. Epub 2018 Jul 13.

Introduction: Although death is common in emergency departments, there is limited research regarding ED design as an obstacle to end-of-life care. This study identifies emergency nurses' recommendations regarding ways designs have negative or positive impact on care for dying patients and their families.

Methods: A 25-item questionnaire was sent to a national random sample of 500 emergency nurses. Inclusion criteria were nurses who could read English, worked in emergency departments, and had cared for at least 1 patient at the end of life (EOL). Responses were individually reviewed and coded.

Results: Major obstacles included (1) issues related to limited space, (2) poor department layout and design, and (3) lack of privacy. Despite emergency departments being a challenging place to provide EOL care, positive ED design characteristics had impact on EOL care.

Discussion: Emergency nurses understand the need for family presence during resuscitation, for secure body stowage areas, and for more resuscitation rooms so that families have time to grieve before being removed because of the immediate needs of a second trauma patient. Nurses can evaluate existing facilities to identify areas in which potential change and remodeling could improve care, increase patient privacy, or further utilize space. Understanding ED design's impact on EOL care is crucial. Modifications to ED layout and design may be challenging; however, improvements to space, layout, and privacy need to be considered when planning new emergency departments or remodeling existing departments. Further research is required to determine the impact of ED design on EOL care.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jen.2018.05.014DOI Listing
May 2019

A Whooping Cough Education Module for WIC Clients in Utah.

MCN Am J Matern Child Nurs 2017 Sep/Oct;42(5):283-288

Karlen E. Luthy is an Associate Professor, Brigham Young University, Provo, UT. The author can be reached via e-mail at Alicia Anderson is a Graduate Student, Brigham Young University, Provo, UT. Janelle Macintosh is an Assistant Professor, Brigham Young University, Provo, UT. Renea L. Beckstrand is a Professor, Brigham Young University, Provo, UT. Lacey M. Eden is an Assistant Teaching Professor, Brigham Young University, Provo, UT. Ryan Amy is an Operations Manager, Brigham Young University, Provo, UT. Christopher I. Macintosh is a Clinical Modeling Engineer, Intermountain Healthcare, West Valley, UT.

Background: Clients in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) are required to complete education modules quarterly to maintain eligibility. The purposes of this project were to: (1) create a whooping cough vaccination education module for WIC clients; (2) evaluate baseline perceptions of WIC clients on the whooping cough vaccine and disease; and (3) evaluate whooping cough knowledge following completion of the module.

Problem: A decline in vaccination rates among infants and children using WIC services was reported by a local WIC program director who requested whooping cough vaccination education materials. This quality improvement project included development of a whooping cough education module and evaluation of learning.

Methods: Learning was evaluated using a pre- and posttest design. Client feedback was solicited via open-ended questions. Quantitative analysis was performed on visual analog-type questions with paired t-tests and a Cohen's d. Content analysis was conducted on open-ended items.

Interventions: The module was designed by a team of vaccination experts and included general definitions, signs and symptoms during the three stages of disease, recommendations to prevent whooping cough, and vaccination recommendations. Learning of users of the module was then evaluated.

Results: After using the module, clients indicated they were significantly more likely to vaccinate themselves and their child against whooping cough, and to recommend the vaccination to their family members. The greatest concern of participants about whooping cough was how it affected infants. Participants reported they learned new information on disease seriousness, recognition of symptoms, and treatment options but still requested additional information on the whooping cough disease and vaccine.

Conclusions: A whooping cough education module is an effective strategy to improve whooping cough knowledge and promote the whooping cough vaccine.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/NMC.0000000000000358DOI Listing
November 2017

Critical Care Nurses' Suggestions to Improve End-of-Life Care Obstacles: Minimal Change Over 17 Years.

Dimens Crit Care Nurs 2017 Jul/Aug;36(4):264-270

Renea L. Beckstrand, PhD, RN, CCRN, CNE, is a professor at Brigham Young University College of Nursing, Provo, Utah. In addition to teaching, she works as a staff nurse in the CVICU at Utah Valley Hospital, Provo, Utah. Kacie Hart Hadley, BS, RN, is a graduate student in the Family Nurse Practitioner Master Program at Brigham Young University College of Nursing. She also works as a staff RN on the CPCU at Utah Valley Hospital, Provo, Utah. Karlen E. Luthy, DNP, FNP-c, FAAN, is an associate professor, Brigham Young University College of Nursing, Provo, Utah. She also works as a Family Nurse Practitioner. Janelle L. B. Macintosh, PhD, RN, is an associate professor, Brigham Young University College of Nursing, Provo, Utah. She is an expert in qualitative research.

Background: Critical-care nurses (CCNs) provide end-of-life (EOL) care on a daily basis as 1 in 5 patients dies while in intensive care units. Critical-care nurses overcome many obstacles to perform quality EOL care for dying patients.

Objectives: The purposes of this study were to collect CCNs' current suggestions for improving EOL care and determine if EOL care obstacles have changed by comparing results to data gathered in 1998.

Methods: A 72-item questionnaire regarding EOL care perceptions was mailed to a national, geographically dispersed, random sample of 2000 members of the American Association of Critical-Care Nurses. One of 3 qualitative questions asked CCNs for suggestions to improve EOL care. Comparative obstacle size (quantitative) data were previously published.

Results: Of the 509 returned questionnaires, 322 (63.3%) had 385 written suggestions for improving EOL care. Major themes identified were ensuring characteristics of a good death, improving physician communication with patients and families, adjusting nurse-to-patient ratios to 1:1, recognizing and avoiding futile care, increasing EOL education, physicians who are present and "on the same page," not allowing families to override patients' wishes, and the need for more support staff. When compared with data gathered 17 years previously, major themes remained the same but in a few cases changed in order and possible causation.

Conclusion: Critical-care nurses' suggestions were similar to those recommendations from 17 years ago. Although the order of importance changed minimally, the number of similar themes indicated that obstacles to providing EOL care to dying intensive care unit patients continue to exist over time.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/DCC.0000000000000252DOI Listing
November 2018

Rural Emergency Nurses' Suggestions for Improving End-of-Life Care.

J Emerg Nurs 2017 May;43(3):214-220

Provo, UT.

Many patient visits to emergency departments result in the patient dying or being pronounced dead on arrival. The numbers of deaths in emergency departments are likely to increase as a significant portion of the U.S. population ages. Consequently, emergency nurses face many obstacles to providing quality end-of-life (EOL) care when death occurs. The purpose of this study was to identify suggestions that emergency nurses have to improve EOL care, specifically in rural emergency departments.

Methods: A 57-item questionnaire was sent to 53 rural hospitals in 4 states in the Intermountain West, plus Alaska. One item asked nurses to identify the one aspect of EOL care they would change for dying patients in rural emergency departments. Each qualitative response was individually reviewed by a research team and then coded into a theme.

Results: Four major themes and three minor themes were identified. The major themes were providing greater privacy during EOL care for patients and family members, increasing availability of support services, additional staffing, and improved staff and community education.

Discussion: Providing adequate privacy for patients and family members was a major obstacle to providing EOL care in the emergency department, largely because of poor department design, especially in rural emergency departments where space is limited. Lack of support services and adequate staffing were also obstacles to providing quality EOL care in rural emergency departments. Consequently, rural nurses are commonly pulled away from EOL care to perform ancillary duties because additional support personnel are lacking. Providing EOL care in rural emergency departments is a challenging task given the limited staffing and resources, and thus it is imperative that nurses' suggestions for improvement of EOL care be acknowledged. Because of the current lack of research in rural EOL care, additional research is needed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jen.2017.03.012DOI Listing
May 2017

Global Immunizations: Health Promotion and Disease Prevention Worldwide.

MCN Am J Matern Child Nurs 2017 May/Jun;42(3):139-145

Janelle L. B. Macintosh is an Assistant Professor at Brigham Young University College of Nursing, Provo, UT. The author can be reached via e-mail at Lacey M. Eden is an Assistant Professor at Brigham Young University College of Nursing, Provo, UT. Karlen E. Luthy is an Associate Professor at Brigham Young University College of Nursing, Provo, UT. Aimee E. Schouten is a BSN student at Brigham Young University College of Nursing, Provo, UT.

Background: Immunizations are one of the most important health interventions of the 20th century, yet people in many areas of the world do not receive adequate immunizations. Approximately 3 million people worldwide die every year from vaccine-preventable diseases; about half of these deaths are young children and infants. Global travel is more common; diseases that were once localized now can be found in communities around the world.

Problem: Multiple barriers to immunizations have been identified. Healthcare access, cost, and perceptions of safety and trust in healthcare are factors that have depressed global immunization rates.

Interventions: Several global organizations have focused on addressing these barriers as part of their efforts to increase immunization rates. The Bill and Melinda Gates Foundation, The World Health Organization, and the United Nations Children's Emergency Fund each have a part of their organization that is concentrated on immunizations.

Clinical Implications: Maternal child nurses worldwide can assist in increasing immunization rates. Nurses can participate in outreach programs to ease the burden of patients and families in accessing immunizations. Nurses can work with local and global organizations to make immunizations more affordable. Nurses can improve trust and knowledge about immunizations in their local communities. Nurses are a powerful influence in the struggle to increase immunization rates, which is a vital aspect of global health promotion and disease prevention.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/NMC.0000000000000337DOI Listing
September 2017

Critical Care Nurses' Perceptions of End-of-Life Care Obstacles: Comparative 17-Year Data.

Dimens Crit Care Nurs 2017 Mar/Apr;36(2):94-105

Renea L. Beckstrand, PhD, RN, CCRN, CNE, is a professor, Brigham Young University College of Nursing, Provo, Utah. Nicole Lamoreaux, MS, FNP-c, is a graduate student, CV ICU, Utah Valley Hospital, Provo. Karlen E. Luthy, DNP, FNP-c, FAAN, FAANP, is an associate professor, Brigham Young University College of Nursing, Provo, Utah. Janelle L.B. Macintosh, PhD, RN, is an associate professor, Brigham Young University College of Nursing, Provo, Utah.

Background: Nurses working in intensive care units (ICUs) frequently care for patients and their families at the end of life (EOL). Providing high-quality EOL care is important for both patients and families, yet ICU nurses face many obstacles that hinder EOL care. Researchers have identified various ICU nurse-perceived obstacles, but no studies have been found addressing the progress that has been made for the last 17 years.

Objective: The aims of this study were to determine the most common and current obstacles in EOL care as perceived by ICU nurses and then to evaluate whether meaningful changes have occurred since data were first gathered in 1998.

Methods: A quantitative-qualitative mixed methods design was used. A random, geographically dispersed sample of 2000 members of the American Association of Critical-Care Nurses was surveyed.

Results: Five obstacle items increased in mean score and rank as compared with 1999 data including (1) family not understanding what the phrase "lifesaving measures" really means, (2) providing lifesaving measures at families' requests despite patient's advance directive listing no such care, (3) family not accepting patient's poor prognosis, (4) family members fighting about the use of life support, and (5) not enough time to provide EOL care because the nurse is consumed with lifesaving measures attempting to save the patient's life. Five obstacle items decreased in mean score and rank compared with 1999 data including (1) physicians differing in opinion about care of the patient, (2) family and friends who continually call the nurse rather than calling the designated family member, (3) physicians who are evasive and avoid families, (4) nurses having to deal with angry families, and (5) nurses not knowing their patient's wishes regarding continuing with tests and treatments.

Conclusions: Obstacles in EOL care, as perceived by critical care nurses, still exist. Family-related obstacles have increased over time. Obstacles related to families may not be easily overcome as each family, dealing with a dying family member in an ICU, likely has not previously experienced a similar situation. On the basis of the current top 5 obstacles, recommendations for possible areas of focus include (1) improved health literacy assessment of families followed by earlier directed, appropriate, and specific EOL information; (2) improved physician/team communication; and (3) ensuring patients' wishes are followed as written. In general, patient- and family-centered care using clear and open EOL communication regarding wishes and desires between patients and families, their physicians, and nurses will help decrease common obstacles, thus improving the quality of EOL care provided to dying patients and families.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/DCC.0000000000000234DOI Listing
August 2018

Immunization Status of NICU Graduates at a Tertiary Care Children's Hospital.

Adv Neonatal Care 2017 Apr;17(2):E3-E9

College of Nursing, Brigham Young University, Provo, Utah.

Background: Approximately 500,000 infants are born prematurely each year in the United States. Immunization of infants in a neonatal intensive care unit (NICU) set a precedence for future immunizations.

Purposes: The objectives of this study were to determine the current rates of immunization and identify variables associated with immunizations of NICU graduates who were aged 60 days or older at time of discharge.

Methods: This descriptive pilot study utilized retrospective paper medical record review in one tertiary children's hospital. The relationships between immunization status and study variables were examined using t tests and logistic regression.

Results: Of 43 infants discharged at least 60 days of age or older from the NICU, 74.4% were fully immunized in accordance with American Academy of Pediatrics (AAP) recommendations. Significant predictors were age at discharge for immunization and steroid use for nonimmunization.

Implications For Practice: Immunization needs to be a priority in order to give NICU infants every advantage regarding their future health status. Nurses need to implement hospital policies ensuring immunizations of NICU graduates.

Implications For Research: Future studies should focus on samples from diverse hospitals and levels of NICUs. Qualitative studies exploring and describing parent and provider knowledge of current AAP guidelines will strengthen our understanding of potential barriers to immunization.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/ANC.0000000000000357DOI Listing
April 2017

Evaluation of Employee Vaccination Policies in Outpatient Oncology Clinics: A Pilot Study.

Clin J Oncol Nurs 2016 Oct;20(5):492-7

Thyroid Institute of Utah.

Background: All major hospital facilities in the state of Utah have employee vaccination policies. However, the presence of healthcare worker vaccination policies in outpatient oncology clinics was unknown.

Objectives: The objectives of this article are to identify oncology outpatient employee vaccination policies in Utah and to identify what consequences, if any, are present for unvaccinated employees.

Methods: This was a cross-sectional, descriptive study design in which clinic managers from outpatient oncology clinics were asked, via questionnaire, to describe the clinic's employee vaccination policy and the consequences for refusing the policy.

Findings: Most vaccination policies applied to employees primarily assigned to work in the direct patient care area. Most commonly, influenza and hepatitis B vaccines were required as part of the vaccination policy. Most managers offered free vaccinations to employees, but most managers also allowed employees to refuse to follow the vaccination policy for medical, religious, or personal reasons.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1188/16.CJON.492-497DOI Listing
October 2016

Vaccination policies of Utah family practice clinics.

J Am Assoc Nurse Pract 2017 Feb 26;29(2):77-84. Epub 2016 Jul 26.

Utah County Health Department, Provo, Utah.

Background And Purpose: The purpose of this study was to collect information regarding healthcare worker (HCW) vaccination policies in Utah family practice clinics.

Methods: The study was conducted in Utah family practice clinics in the most densely populated counties in the state and was a cross-sectional descriptive design. Data were collected from 91 family practice clinic managers. Descriptive statistics were performed, as well as a content analysis for open-ended items.

Conclusions: HCWs are employed in environments where infectious diseases can be easily spread from person to person, thus, vaccinations can be instrumental in protecting the health of HCWs and patients alike. In Utah, 56.8% of family practice clinics had either no vaccination policy for HCWs or had a policy with no consequences for noncompliance. Utah family practice clinics need to implement changes to create and maintain HCW vaccination policies.

Implications For Practice: Nurse practitioners can be leaders and change agents by working with their county and state health departments to create state-wide policies that mirror the position statements from the American Nurses Association and the American Association of Nurse Practitioners.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/2327-6924.12395DOI Listing
February 2017

Promoting Adult Pertussis Vaccination in the Workplace.

Workplace Health Saf 2016 Jun;64(6):269-78

Brigham Young University.

Vaccines are an important disease prevention strategy among individuals of all age groups. Despite the success of vaccinations in preventing communicable diseases, adults, in particular, often have sub-optimal vaccination rates. Consequently, some vaccine-preventable diseases, such as pertussis, are still on the rise in the United States despite the availability of the Tdap vaccine. As most adults can be found in the workplace, occupational and environmental health nurses are in a unique position to encourage employers to promote adequate Tdap vaccination among their employees. As specific resources regarding Tdap vaccination are lacking, the Pertussis Prevention Toolkit was developed to help occupational health nurses promote Tdap vaccination in the workplace.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/2165079916628883DOI Listing
June 2016

Rural Emergency Nurses' End-of-Life Care Obstacle Experiences: Stories from the Last Frontier.

J Emerg Nurs 2017 Jan 26;43(1):40-48. Epub 2015 Sep 26.

Provo, UT.

Rural emergency nurses face unique obstacles to providing quality end-of-life (EOL) care. Stories provided by emergency nurses embody their most difficult EOL care obstacles.

Methods: A questionnaire was sent to 53 rural hospitals. Respondents were asked to share stories that epitomized the obstacles faced while providing EOL care in the rural emergency setting.

Results: The lack of an ideal death (eg, the nurse personally knows the patient, issues with family members, and unknown patient wishes) was the top obstacle. Other reported obstacles were insufficient ED staff and power struggles between nurses and physicians.

Discussion: Rural emergency nurses often provide EOL care to friends and family members, whereas their urban counterparts are likely to transfer care to nurses with no relation to the dying patient. Not only does caring for patients whom the nurse knows or is related to cause great distress to rural emergency nurses, but this unfortunately common situation also may prevent patients from receiving the highest quality EOL care.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jen.2015.08.017DOI Listing
January 2017

Addressing Parental Vaccination Questions in the School Setting: An Integrative Literature Review.

J Sch Nurs 2016 Feb 23;32(1):47-57. Epub 2015 Sep 23.

Brigham Young University, Provo, UT, USA.

School nurses work in a unique environment with key opportunities to address parental concerns and questions regarding their child's health. A common concern for parents during school enrollment is childhood vaccination safety and efficacy. As public health leaders, school nurses are well respected among parents, therefore school nurses are in a prime position to educate parents and promote childhood vaccinations while also dispelling common vaccination myths. The purpose of this integrative literature review is to synthesize evidence-based answers to common parental questions regarding childhood vaccinations.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1059840515606501DOI Listing
February 2016

Evaluation of Vaccination Policies Among Utah Pediatric Clinic Employees.

J Pediatr Health Care 2016 May-Jun;30(3):190-6. Epub 2015 Aug 4.

Introduction: Pediatric health care settings are high-risk environments for spreading communicable and vaccine-preventable diseases from health care workers to susceptible patients.

Method: All managers of pediatric clinics operating in the state of Utah were included. Participants were invited to complete a two-page questionnaire regarding their clinic vaccination policies.

Results: Half (n = 23) of Utah pediatric outpatient clinic managers recommend employee vaccinations, although employee refusal was allowed without consequence. Of all adult vaccines, influenza was most often included by managers as part of the employee vaccination policy. Some managers required unvaccinated employees to wear masks in the event of illness, but many had no additional requirements for unvaccinated and ill employees.

Discussion: Vaccination of health care workers is an effective approach to reduce disease transmission. Mandatory vaccination policies can significantly improve vaccination rates among health care workers.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.pedhc.2015.06.007DOI Listing
September 2017

Perception of safety, importance, and effectiveness of vaccinations among urban school employees in Utah.

J Am Assoc Nurse Pract 2015 Jun 11;27(6):313-20. Epub 2015 Mar 11.

College of Nursing, Brigham Young University, Provo, Utah.

Purpose: School employees are in direct contact with children in confined areas, a setting in which communicable infection can quickly spread. Therefore, it is important for school employees to be fully vaccinated. The purpose of this study is to ascertain the current vaccination status and perceptions of school employees in an urban school district.

Data Sources: The study employed a nonexperimental mixed-method design. School employee participants (N = 1400) completed a questionnaire to evaluate vaccination status, availability of vaccination records, and vaccination awareness. Participants were randomly selected from 85 schools within one urban school district.

Conclusions: Two common perceptions about vaccines emerged from the questionnaire: (a) vaccines are only for children and (b) vaccinations received during childhood are still effective. School employees are unaware of their own vaccination status and the recommended vaccination schedule for adults. Additionally, accessibility to immunization records for adults is frequently inadequate.

Implications For Practice: Healthcare providers (HCPs), including nurse practitioners (NPs), are the first line of defense to ensure adults are adequately vaccinated. When vaccinations are tracked and recommended by HCPs, vaccination uptake is improved. NPs who discuss recommended vaccinations with adult patients are instrumental in improving vaccination rates among school employees.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/2327-6924.12233DOI Listing
June 2015

Vaccination perceptions of school employees in a rural school district.

Vaccine 2014 Aug 10;32(37):4766-71. Epub 2014 Jul 10.

Brigham Young University, College of Nursing, 500 SWKT, Provo, UT 84602, United States.

Background: There continues to be a need for increases in adult vaccination rates, especially among those working in environments which may easily become communicable disease outbreak centers, such as school employees in the school environment. The purpose of this study was to evaluate why rural Utah school employees were non-compliant with the influenza and measles, mumps, and rubella (MMR) vaccines, as well as to identify their views on mandatory vaccination policies.

Methods: A questionnaire was distributed to all school employees in a rural Utah school district. Data analysis included frequencies and measures of central tendency and dispersion for quantitative items and theme identification for qualitative items.

Results: Only 51% of school employees were adequately vaccinated for influenza. Reasons for noncompliance with the influenza vaccine included inconvenience, lack of perceived need, and questionable vaccine efficacy. There were 39.3% school employees who had not received an MMR during adulthood, which was commonly attributed to lack of knowledge regarding the need for this vaccine. Almost half (45.7%) of school employees believed a mandatory vaccination policy should be instituted, although 24.2% of school employees were opposed to mandatory adult vaccination policies. Reasons for opposing vaccination mandates included violation of personal choice, lack of perceived vaccination safety and efficacy, lack of perceived need for adult vaccines, and vaccine cost.

Conclusions: Suboptimal vaccination rates of school employees may negatively affect the health and well-being of individuals in the school environment. School employees report a variety of beliefs regarding the influenza and MMR vaccines. While over half of school employees support mandatory vaccination policies for adults working in the school environment, those opposing such a policy report concerns regarding violation of personal choice. Public health officials and school administrators should coordinate efforts to increase vaccination rates among adults in the school environment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.vaccine.2014.06.029DOI Listing
August 2014

Postpartum depression in immigrant Hispanic women: a comparative community sample.

J Am Assoc Nurse Pract 2014 Sep 25;26(9):488-97. Epub 2013 Nov 25.

Glendive Medical Center, Glendive, Montana.

Purpose: To determine whether a high rate of postpartum depression (PPD), previously found in immigrant Hispanic women at a community clinic, would also be found in a community sample.

Data Sources: Sixty women from local community settings were given the PPDS-S instrument and the General Acculturation Index to screen for PPD symptoms. Data were then compared with previously published community clinic data.

Conclusion: Sixty percent of the immigrant Hispanic women showed significant PPD. The only statistically significant positive predictive factor for increased PPD symptoms was having a previous history of depression. In addition, 54% had an elevated symptom content profile score for suicidal thinking.

Implications For Practice: Health practitioners should be aware of a potentially high rate of PPD in this population, especially in light of previously studied increased rates of suicide attempts in Latinas. If a prior history of depression is predictive of PPD, it is possible that many of the mothers in our sample suffered from depression prior to the postpartum period, but were not appropriately diagnosed or treated. Recommendations for outreach and further research are discussed. In particular, further research regarding the prenatal prevalence of depression in immigrant Hispanic women is recommended in order to further understand the high incidence of PPD.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/2327-6924.12088DOI Listing
September 2014

Statins' effect on plasma levels of Coenzyme Q10 and improvement in myopathy with supplementation.

J Am Assoc Nurse Pract 2014 Feb 12;26(2):85-90. Epub 2013 Jul 12.

The Orthopedic Specialty Group, LDS Hospital Orthopedics, Salt Lake City, Utah.

Purpose: Heart disease is the leading cause of death in the United States. HMG-CoA reductase inhibitors, or statins, are medications at the forefront of the battle against cardiovascular disease. Despite their effectiveness, patient compliance with statins has lagged because of medication cost and adverse effects, namely myopathy. Myopathy is the most common side effect of statin use. The purpose of this review is to report plasma levels of CoQ10 in patients taking statins and then to determine the benefit of Coenzyme Q10 (CoQ10) supplementation on statin-related myopathy as evidenced by symptomatic improvement and increase in serum levels of CoQ10.

Data Sources: CINAHL, Medline, Health Source: Nursing/Academic Edition, and Cochrane Library.

Conclusions: Evidence from this review suggests that studies showed a significant relationship between statin intake and decreased serum levels of CoQ10. A few studies showed a benefit in symptoms of myalgia or improvement of serum levels of CoQ10 with supplementation. One study showed no benefit of CoQ10 supplementation when taken with statins. There were no risks of supplementation reported in any of the studies.

Implications For Practice: CoQ10 supplementation might benefit those patients suffering from statin-induced myopathy as evidenced by the results of these studies. Supplementation of CoQ10 at a dose of between 30 and 200 mg daily has shown to have beneficial effects on statin myopathy with no noted side effects. Further research is necessary.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/2327-6924.12046DOI Listing
February 2014

Vaccinating parents experience vaccine anxiety too.

J Am Assoc Nurse Pract 2013 Dec 17;25(12):667-73. Epub 2013 Jun 17.

Brigham Young University, Provo, Utah.

Purpose: To identify common causes of parental anxiety regarding childhood vaccinations among parents who vaccinate. Another purpose was to seek recommendations for healthcare providers to help parents overcome their anxiety when their children are immunized.

Data Sources: Four 1-h focus groups were conducted, each consisting of 8-10 parents. Each focus group discussion was conducted by a moderator and an assistant moderator. The moderator facilitated discussion while the assistant moderator took notes. Each session was recorded on video. The data were transcribed and analyzed for themes.

Conclusions: Parents identifying themselves as being compliant with childhood vaccination requirements reported anxiety that can be divided into five major themes: parental anxiety prior to vaccination, parental anxiety during the vaccination, parental anxiety after the vaccination, parental suggestions for healthcare providers, and informational issues.

Implications For Practice: Making minor changes in office policies may help alleviate some parental anxiety regarding vaccinations. Providers should also create lists of credible sources about vaccination information. Because the cause of vaccine-related parental anxiety varies, targeted education is necessary to relieve common causes of vaccine anxiety, even among parents who vaccinate.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/2327-6924.12034DOI Listing
December 2013

Rural school employees' status, awareness, and perceptions of adult vaccinations.

J Sch Nurs 2013 Aug 23;29(4):294-302. Epub 2013 May 23.

College of Nursing, Brigham Young University, Provo, UT 84602, USA.

As key members of the school environment, it is important for school employees to be vaccinated. Employees are in direct contact with children in close quarters for long periods of time and such an environment can easily serve as an outbreak center for vaccine-preventable communicable diseases such as measles. Despite the fact that most school employees believe vaccines are safe and effective and many school employees report they are up-to-date with their vaccines, a closer examination reveals discrepancy between belief and behavior. This research study evaluates the vaccination status, awareness, and perceptions of school employees located in a large rural school district in Utah. As a vaccine advocate, the school nurse can be influential in providing adult vaccination education for school employees, thus increasing awareness of the importance of adult vaccines and knowing one's vaccination status. Additionally, school nurses might need to meet with school district policy makers to promote vaccine mandates for school employees and to assist in the creation of containment plans in the event of a measles outbreak at school.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1059840513491118DOI Listing
August 2013

Vaccination perceptions and barriers of school employees: a pilot study.

J Sch Nurs 2013 Aug 16;29(4):284-93. Epub 2013 May 16.

College of Nursing, Brigham Young University, Provo, UT 84602, USA.

Schools are where vaccine-preventable diseases can spread. Vaccination of school children has been studied; however, data are lacking on the vaccination status, perceptions, and barriers to vaccination for school employees. We surveyed school employees' vaccination perceptions, awareness of current vaccination status, and potential barriers to vaccinations. Adult vaccination knowledge is lacking in the school employee population. School employees were unaware of their vaccination status for diseases such as measles and pertussis. Most subjects believed vaccinations were safe and effective, although they believed vaccinations were more important for children than adults. Many believed vaccine mandates should exist for school employees. Knowledge gaps regarding adult vaccines can be positively influenced by school nurses. Gaps may be especially important to bridge regarding adults working in the school setting, an environment ideal for the spreading of communicable diseases.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1059840513490029DOI Listing
August 2013

Assessment, management, and prevention of childhood temper tantrums.

J Am Acad Nurse Pract 2012 Oct 2;24(10):569-73. Epub 2012 Jul 2.

Mountain Springs Family Medicine, Spanish Fork, UT 84660, USA.

Purpose: To provide an overview of normal and abnormal temper tantrum behavior as well as give recommendations nurse practitioners (NPs) can use in counseling families.

Data Sources: Articles were identified from the following databases: CINAHL, HEALTH SOURCE: Nursing/Academic edition, Medline, Social Work Abstracts, Social Science Abstracts, Psych INFO, Psychology and Behavioral Science Collection. Textbook references were also identified using Stat!Ref.

Conclusions: Temper tantrums are one of the most common behavior problems in children. Although most children will have tantrums, with NPs' support and guidance in primary care encounters, most children will not require further intervention.

Implications For Practice: NPs caring for children will need to identify normal and abnormal tantrum behavior as well as rule out other causes of tantrums in order to help parents handle the tantrum behavior. To obtain CE credit for this activity, go to http://www.aanp.org and click on the CE Center. Locate the listing for this article and complete the post-test. Follow the instructions to print your CE certificate.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/j.1745-7599.2012.00755.xDOI Listing
October 2012

Oncology nurses' obstacles and supportive behaviors in end-of-life care: providing vital family care.

Oncol Nurs Forum 2012 Sep;39(5):E398-406

College of Nursing, Brigham Young University, Provo, UT, USA.

Purpose/objectives: To determine the impact of obstacles and supportive behaviors in end-of-life (EOL) care as perceived by hospital-based oncology nurses.

Design: A 69-item mailed survey.

Setting: National random sample.

Sample: 1,005 nurse members of the Oncology Nursing Society who had provided EOL care for patients with cancer.

Methods: Three mailings yielded 380 usable responses from 912 eligible respondents, resulting in a 42% return rate.

Main Research Variables: Size and frequency of EOL care obstacles and supportive behaviors for patients with cancer in a hospital setting.

Findings: Results of this research demonstrate the need for more EOL education and help in forming teams of nurses, social and palliative care workers, and physicians to support high-quality care. Another finding was the need for other nurses at a facility to give the nurse caring for the dying patient more time to support the patient and family.

Conclusions: Dealing with the family is vital in providing optimal EOL care to patients dying from cancer. By carefully listening to the experience, concerns, and recommendations of hospital-based oncology nurses, compassionate EOL care can be provided to these patients and their families.

Implications For Nursing: Oncology nurses are dedicated to providing the best EOL care to their patients and patients' families. This study helped to identify research-based obstacles and supportive behaviors regarding the provision of high-quality EOL care.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1188/12.ONF.E398-E406DOI Listing
September 2012

Common perceptions of parents requesting personal exemption from vaccination.

J Sch Nurs 2013 Apr 25;29(2):95-103. Epub 2012 Jul 25.

Brigham Young University, Provo, UT, USA.

School nurses, as vaccination advocates, need to be aware of parents' common concerns regarding vaccines, so the nurse can develop strategies to communicate with parents. The purpose of this cross-sectional, descriptive study was to identify common reasons parents in Utah seek exempting rather than vaccinating their children. Data were collected from a convenience sample of 801 parents responding to a 16-item questionnaire about why they exempted their children from receiving vaccinations. The most commonly reported reason for seeking a personal exemption included vaccines conflicting with philosophical beliefs. Parents exempting from one vaccine most commonly exempted the hepatitis series. Most parents communicated their vaccine concerns with their health care provider prior to seeking exemption. The majority of exempting parents did not use the Internet when researching vaccines even though they had Internet access. Considering the common vaccine-related perceptions of parents may be helpful when developing strategies to overcome these barriers to vaccination.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1059840512455365DOI Listing
April 2013

Emergency nurses' suggestions for improving end-of-life care obstacles.

J Emerg Nurs 2012 Sep 22;38(5):e7-14. Epub 2012 Jun 22.

College of Nursing, Brigham Young University, Provo, UT 84602, USA.

Introduction: More than 123 million ED visits are reported annually. Many patients who arrive for care to help extend their lives instead die while in the emergency department. Emergency departments were designed to save lives rather than to provide optimal end-of-life (EOL) care. Emergency nurses care for these dying patients and their families. The purpose of this study was to determine what suggestions emergency nurses have for improving EOL care.

Methods: Emergency nurses were asked which aspects of EOL care they would like to see changed to improve how patients die in emergency departments. Of the 1000 nurses surveyed, 230 provided a total of 295 suggestions for improving EOL care. Content analysis was used to identify categories of qualitative responses. Responses were coded individually by research team members and then compared with ED EOL literature. Clusters of data were formulated to form themes with sufficient data returned to reach saturation.

Results: Five major themes and four minor themes were identified. The major themes were increasing the amount of time ED nurses have to care for dying patients, allowing family presence during resuscitation, providing comfortable patient rooms, providing privacy, and providing family grief rooms.

Conclusion: Large numbers of patients seek care in emergency departments. Emergency nurses are often called on to care for dying patients and their families in this highly technical environment, which was designed to save lives. Emergency nurses witness the obstacles surrounding EOL care in emergency departments, and their recommendations for improving EOL care should be implemented when possible.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jen.2012.03.008DOI Listing
September 2012