• Audiovisual recording in the emergency department: Ethical and legal issues

      Iserson, Kenneth V; Allan, Nathan G; Geiderman, Joel M; Goett, Rebecca R; Univ Arizona, Dept Emergency Med (W B SAUNDERS CO-ELSEVIER INC, 2019-08-27)
      Emergency physicians, organizations and healthcare institutions should recognize the value to clinicians and patients of HIPAA-compliant audiovisual recording in emergency departments (ED). They should promote consistent specialty-wide policies that emphasize protecting patient privacy, particularly in patient-care areas, where patients and staff have a reasonable expectation of privacy and should generally not be recorded without their prospective consent. While recordings can help patients understand and recall vital parts of their ED experience and discharge instructions, using always-on recording devices should be regulated and restricted to areas in which patient care is not occurring. Healthcare institutions should provide HIPAA-compliant methods to securely store and transmit healthcare-sensitive recordings and establish protocols. Protocols should include both consent procedures their staff can use to record and publish (print or electronic) audiovisual images and appropriate disciplinary measures for staff that violate them. EDs and institutions should publicly post their rules governing ED recordings, including a ban on all surreptitious or unconsented recordings. However, local institutions may lack the ability to enforce these rules without multi-party consent statutes in those states (the majority) where it doesn't exist. Clinicians imaging patients in international settings should be guided by the same ethical norms as they are at their home institution. Copyright © 2019. Published by Elsevier Inc.
    • Bradyarrhythmias: Clinical Presentation, Diagnosis, and Management.

      Wung, Shu-Fen; Univ Arizona, Coll Nursing (W B SAUNDERS CO-ELSEVIER INC, 2016-09)
      Bradyarrhythmias are common clinical findings consisting of physiologic and pathologic conditions (sinus node dysfunction and atrioventricular [AV] conduction disturbances). Bradyarrhythmias can be benign, requiring no treatment; however, acute unstable bradycardia can lead to cardiac arrest. In patients with confirmed or suspected bradycardia, a thorough history and physical examination should include possible causes of sinoatrial node dysfunction or AV block. Management of bradycardia is based on the severity of symptoms, the underlying causes, presence of potentially reversible causes, presence of adverse signs, and risk of progression to asystole. Pharmacologic therapy and/or pacing are used to manage unstable or symptomatic bradyarrhythmias.
    • Clinical and Community Strategies to Prevent Falls and Fall-Related Injuries Among Community-Dwelling Older Adults

      Taylor-Piliae, Ruth E.; Peterson, Rachel; Mohler, Martha Jane; Univ Arizona, Coll Nursing; Univ Arizona, Coll Med, Arizona Ctr Aging; Univ Arizona, Coll Med, Div Geriatr Gen Internal Med & Palliat Med; Univ Arizona, Mel & Enid Zuckerman Coll Publ Hlth (W B SAUNDERS CO-ELSEVIER INC, 2017-09)
      Falls in older adults are the result of several risk factors across biological and behavioral aspects of the person, along with environmental factors. Falls can trigger a downward spiral in activities of daily living, independence, and overall health outcomes. Clinicians who care for older adults should screen them annually for falls. A multifactorial comprehensive clinical fall assessment coupled with tailored interventions can result in a dramatic public health impact, while improving older adult quality of life. For community-dwelling older adults, effective fall prevention has the potential to reduce serious fall-related injuries, emergency room visits, hospitalizations, institutionalization, and functional decline.
    • Critical Care Nurses' Cognitive Ergonomics Related to Medical Device Alarms

      Wung, Shu-Fen; Schatz, Marilyn Rose; Univ Arizona, Coll Nursing, Biobehav Hlth Sci Div (W B SAUNDERS CO-ELSEVIER INC, 2018-06-01)
      This study uniquely gained insight into the intricacy of intensive care nurses' decision-making process when responding to and managing device alarms. Difficulty in responding to alarms included low staffing, multiple job responsibilities, and competing priority tasks. Novice nurses are more tolerant of alarms sounding owing to a lower threshold of comfort with resetting or silencing alarms; more experienced nurses are more comfortable resetting alarm limits to the patient's baseline. Understanding the decision-making process used by nurses can guide the development of policies and learning experiences that are crucial clinical support for alarm management.
    • The differential effects of PTSD, MDD, and dissociation on CRP in trauma-exposed women

      Powers, Abigail; Dixon, Hayley Drew; Conneely, Karen; Gluck, Rachel; Munoz, Adam; Rochat, Cleo; Mendoza, Hadrian; Hartzell, Georgina; Ressler, Kerry J; Bradley, Bekh; et al. (W B SAUNDERS CO-ELSEVIER INC, 2019-08)
      Correlational results showed a significant association between higher concentrations of hsCRP and child abuse (p < 0.05), overall dissociation severity (p < 0.001), and PTSD symptoms (p < 0.01). ANOVA results showed significantly higher levels of hsCRP in those with current MDD, current PTSD, and remitted PTSD. A hierarchical linear regression model demonstrated a significant association between dissociation symptoms and greater hsCRP levels independent of childhood abuse, PTSD, and MDD (R2∆ = 0.11, p = 0.001) and independent of emotion dysregulation (p < 0.05).
    • Emergency physician care of family members, friends, colleagues and self

      Geiderman, Joel Martin; Marco, Catherine A; Iserson, Kenneth V; Univ Arizona, Dept Emergency Med (W B SAUNDERS CO-ELSEVIER INC, 2019-05-01)
      Emergency Physicians are frequently called upon to treat family members, friends, colleagues, subordinates or others with whom they have a personal relationship; or they may elect to treat themselves. This may occur in the Emergency Department (ED), outside of the ED, as an informal, or "curbside" consultation, long distance by telecommunication or even at home at any hour. In surveys, the vast majority of physicians report that they have provided some level of care to family members, friends, colleagues or themselves, sometime during their professional career. Despite being common, this practice raises ethical concerns and concern for the welfare of both the patient and the physician. This article suggests ethical and practical guidance for the emergency physician as to how to approach these situations. (c) 2019 Elsevier Inc. All rights reserved.
    • Emerging Infectious Diseases

      McArthur, Donna Behler; Univ Arizona, Coll Nursing (W B SAUNDERS CO-ELSEVIER INC, 2019-06-01)
      Emerging infectious diseases (EID) and reemerging infectious diseases are increasing globally. Zoonotic diseases are transmitted from animals to humans through direct contact or through food, water, and the environment. Vector-borne diseases are major sources of mortality and morbidity globally. Three mosquito-borne viruses are yellow fever, chikungunya virus, and dengue virus. Recent EIDs include Candida auris, Elizabethkingia anopheles, The Lone Star tick, and avian influenza H7N2. In addition, mcr-1 may contribute to the dissemination of drug resistance to gram negative bacteria. Nurses play a major role in the identification and prevention of EID within health care settings.
    • Experiences of dual PHD-DNP nursing students during doctoral education

      May, Jennifer T; Littzen, Chloe O R; Morrison, Helena W; Loescher, Lois J; Univ Arizona, Coll Nursing, Biobehav Hlth Sci Div (W B SAUNDERS CO-ELSEVIER INC, 2020-02-12)
      Background: Nursing doctoral education now includes an option with a growing national interest: the PhD-DNP dual degree. Although programs have existed for 10 years, little is known about experiences of dual PhD-DNP degree nursing students (DDNS) during doctoral education, including their perceptions of mentorship during coursework, comprehensive exams, and dissertation readiness. Objective: To explore and describe the experiences of DDNS during hybrid dual doctoral education at one Southwestern university. Method: Using a qualitative descriptive design, DDNS (n = 4) at a Southwestern university were interviewed about their experiences during coursework and comprehensive examinations. Results: Three categories fundamental to DDNS were identified through an inductive and deductive iterative process: coursework experiences, including the key findings of in-betweenness and isolation; mentorship; and comprehensive examination experience. Categories of dissertation readiness and DDNS recommendations were inductively derived. Conclusion: Current interest in the PhD-DNP dual degree underscores the importance of knowing more about the experiences of DDNS. The key findings of in-betweenness and isolation have previously not been described in the nursing literature and need to be considered for the DDNS. Facilitators and inhibitors, mentorship experiences, and mentor attributes affect progression of DDNS through coursework. Strategies for success for DDNS, faculty and program success are provided.
    • Microbiome in Mechanisms of Asthma

      Carr, Tara F; Alkatib, Rhonda; Kraft, Monica; Univ Arizona, Dept Med (W B SAUNDERS CO-ELSEVIER INC, 2019-03-01)
      The lung and gut microbiome are factors in asthma risk or protection. Relevant elements of the microbiome within both niches include the importance of the early life window for microbiome establishment, the diversity of bacteria, richness of bacteria, and effect of those bacteria on the local epithelium and immune system. Mechanisms of protection include direct anti-inflammatory action or induction of non-type 2 inflammation by certain bacterial colonies. The gut microbiome further impacts asthma risk through the contribution of metabolic products. This article reviews the mechanisms that connect the lung and gut microbiota to asthma development and severity.
    • Palliative Care for Pancreatic and Periampullary Cancer

      Perone, Jennifer A.; Riall, Taylor S.; Olino, Kelly; Department of Surgery, Banner-University Medical Center, University of Arizona (W B SAUNDERS CO-ELSEVIER INC, 2016-12)
      Most patients with pancreatic cancer will present with metastatic or locally advanced disease. Unfortunately, most patients with localized disease will experience recurrence even after multimodality therapy. As such, pancreatic cancer patients arrive at a common endpoint where decisions pertaining to palliative care come to the forefront. This article summarizes surgical, endoscopic, and other palliative techniques for relief of obstructive jaundice, relief of duodenal or gastric outlet obstruction, and relief of pain due to invasion of the celiac plexus. It also introduces the utility of the palliative care triangle in clarifying a patient's and family's goals to guide decision making.
    • Selecting a theoretical framework to guide a research study of older adults' perceptions and experiences of falling in the hospital

      Dolan, Hanne; Taylor-Piliae, Ruth; Univ Arizona, Coll Nursing (W B SAUNDERS CO-ELSEVIER INC, 2019-06-01)
      A paucity of research has explored the older adult's experience of falling in the hospital. Understanding the central concepts associated with a fall while hospitalized is essential for further fall prevention research and practice. The purpose of this paper is to describe the process of selecting a theoretical framework to guide a qualitative study exploring the older adult's experience of falling while hospitalized. An analysis of six established illness self-management theories and models from nursing and psychology was conducted using Walker and Avant's framework for theory analysis. The Health Belief Model was selected as the most appropriate theoretical framework, as it entails concepts applicable to the experience of falling and captures the complexity of the phenomenon of inpatient falls, which is important for nursing.