"Mirror, mirror...".
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Evidence-Based Medicine↗
Biomedical subjects
Darlene Sredl
Publications and source records attributed to Darlene Sredl.
Collaborative care management for a pregnant woman with an ostomy.
Pregnant women with an ostomy face many challenges during the prenatal period. Although these challenges may be present, pregnancy in the ostomate is presented as a continuum of health and wellness in this article. Collaborative care professionals, especially nurses and midwives, are often the most accessible professional sources for health care information, but current research and information on this topic is sparse. Ostomy-related problems that may occur during pregnancy, include: intestinal obstruction, peristomal hernia, pouching problems, including the effect of nausea and vomiting on pouch hydration, stomal retraction, stenosis, or laceration, and stomal prolapse. Three types of ostomies are discussed: continent ileostomies, urostomies and colostomies. A description of the normal characteristic appearance of each is also included. Collaborative care from pre-conception through the post partum period is described with emphasis on teaching self-help techniques such as: special nutritional considerations, how to recognize potential problems, and how to fit and adapt appliances to the changing body form of the patient as the pregnancy progresses. Phenomenologic information about the pregnant ostomate's perceptions about her pregnancy experience is also presented. Psycho-prophylaxis methods of complementary therapy alternatives alleviating nausea and vomiting within pregnancy, as well as the pain of childbirth are also presented. Although nursing/midwifery management of a pregnant ostomy patient is a challenge, those challenges are surmountable and outcomes resemble those found in the general population.
Complementary Therapies↗
Helping from my hospital bed.
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Alzheimer Disease↗
An evidence-based pilot study exploring relationships between psychologic and physiologic factors in post-lung-transplant adolescents with cystic fibrosis.
After using an evidence-based approach to address clinical practice questions, a pilot study was designed to explore the relationships among anxiety and depression self-report data, cyclosporine (CSA) trough values, and biopsy rejection grades within a posttransplant sample of adolescents with cystic fibrosis. Thirteen study participants completed the Revised Children's Manifest Anxiety Scale (RCMAS) and the Children's Depression Inventory (CDI), and had CSA trough levels and biopsy data collected. There was a statistically significant correlation between depression and inflammatory rejection levels. Adolescents with benign rejection scores had lower depression scores than adolescents with higher levels of rejection scores. The data also showed a statistically significant inverse correlation between CSA trough levels and inflammatory rejection levels. Posttransplant success depends on compliance with a strict, antirejection regimen. Adolescence is a turbulent time when many stressors can result in risk-taking behavior such as medication noncompliance and anxiety and depression. Regular psychologic monitoring of posttransplant adolescent patients may be warranted to identify increasing psychologic distress and proactive opportunities for health care intervention. This pilot study is an example of a clinical research question that evolved from a practice situation in which nurses caring for posttransplant adolescents with cystic fibrosis surmised that there were many psychologic issues influencing successful transplant outcomes. Nursing observations suggested a strong connection between poorer medication control, greater risk for rejection, and signs of depression and/or anxiety. The nurse researchers were interested in identifying significant relationships between psychologic factors and physiologic factors, and in discovering objective ways to better assess the psychologic needs of this patient population. A thorough search was conducted of the research literature, and the best clinical practices of other institutions were investigated. There was a lack of transplant research literature on adolescents, and although excellent ideas were generated from inquiries to other institutions, there was a lack of best evidence to answer the clinical questions about this group of patients. The initial clinical question became a research question to determine more about this specific patient population. This article is an example of a clinical research pilot study that resulted from an evidence-based practice process. Pilot studies are springboards for other, more refined research: They help to point the way, or to clarify what the real issues may be. For nurses, they serve as an opportunity to hone critical thinking skills and to contribute to the scientific foundation of our profession.
Adolescent↗
Nursing education and professional practice: a collaborative approach to enhance retention.
Factors that have led to the current shortage of nurses include a decrease in school of nursing enrollments, an aging workforce leading to retirement attrition, and a decrease in the numbers of nurses remaining within the profession. Compounding the workforce shortage problem, nurses are becoming more frustrated with work and their work environment. Negative work environment can lead to turnover, or worse still, nurses leaving the profession entirely. The purpose of this article is to identify how schools of nursing can work together with hospitals to achieve quality educational preparation for graduates, promote positive experiences for the student nurse, and assist hospitals with maintaining a positive nurse-friendly environment for the nursing staff.
Education, Nursing↗
Evidence-based nursing care management for the pregnant woman with an ostomy.
Pregnancy presents many problems without working through additional problems in coping with an ostomy. Yet many women with an ostomy do get pregnant and do deliver healthy babies. Evidence-based nursing is of the utmost importance, as there is little published information on this topic. Because of the scarcity of pregnant subjects within the ostomy category, most studies, by necessity, select a purposive subject base. Therefore, other information sources regarding nursing management of the pregnant woman with an ostomy take on considerably more importance. This article explores other forms of evidence that can be used in managing the care of pregnant ostomy patients and specifically how nurses can integrate various sources of information in designing an evidence-based nursing care plan. Nonpharmacologic forms of relaxation therapy, easily used by nurses, such as mindfulness-based stress reduction, guided imagery, and hypnosis, are also identified as some ways nurses can relieve anxiety and experiential stress associated with pregnancy in women who have an ostomy.
Clinical Competence↗
Myths and facts about pain in neonates.
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Humans↗
Designing a nurse refresher course curriculum.
One viable way to increase the ranks of registered nurses employed within nursing is to offer nurse refresher courses to inactive registered nurses. Outcome measures identified in several studies suggested that more than 60% of nurse refresher course graduates retained employment within nursing for 2 years after completing the course. An extensive literature review revealed information on many nurse refresher programs, but no curricula. The purpose of this article is to offer a nurse refresher course curriculum and describe the process by which it was designed.
Curriculum↗
The Triangle Technique: a new evidence-based educational tool for pediatric medication calculations.
Many nursing student verbalize an aversion to mathematical concepts and experience math anxiety whenever a mathematical problem is confronted. Since nurses confront mathematical problems on a daily basis, they must learn to feel comfortable with their ability to perform these calculations correctly. The Triangle Technique, a new educational tool available to nurse educators, incorporates evidence-based concepts within a graphic model using visual, auditory, and kinesthetic learning styles to demonstrate pediatric medication calculations of normal therapeutic ranges. The theoretical framework for the technique is presented, as is a pilot study examining the efficacy of the educational tool. Statistically significant results obtained by Pearson's product-moment correlation indicate that students are better able to calculate accurate pediatric therapeutic dosage ranges after participation in the educational intervention of learning the Triangle Technique.
Adult↗