Relevant bibliographies by topics / Nursing administration

Contents

  1. Journal articles
  2. Dissertations / Theses
  3. Books
  4. Book chapters
  5. Conference papers
  6. Reports

Academic literature on the topic 'Nursing administration'

Author: Grafiati
Published: 4 June 2021
Last updated: 30 January 2023

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Journal articles on the topic "Nursing administration"

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Zelonis, Jaloo I. "Nursing Administration." Journal of Continuing Education in Nursing 21, no. 6 (November 1990): 279. http://dx.doi.org/10.3928/0022-0124-19901101-17.

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&NA;. "NURSING ADMINISTRATION." AJN, American Journal of Nursing 88, no. 12 (December 1988): 1661–62. http://dx.doi.org/10.1097/00000446-198888120-00016.

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Conti, Roberta M. "Nursing Administration." AJN, American Journal of Nursing 90, no. 1 (January 1990): 79. http://dx.doi.org/10.1097/00000446-199001000-00043.

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Friss, Lois. "Nursing Administration." Nursing Management (Springhouse) 18, no. 8 (August 1987): 84???85. http://dx.doi.org/10.1097/00006247-198708000-00020.

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Verran, Joyce A. "Nursing Administration." Journal of Nursing Administration 26, no. 5 (May 1996): 5,6. http://dx.doi.org/10.1097/00005110-199605000-00002.

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&NA;, &NA;. "Nursing Education and Nursing Administration." AJN, American Journal of Nursing 95, no. 7 (July 1995): 52. http://dx.doi.org/10.1097/00000446-199507000-00028.

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Kellnhauser, Edith. "Nursing Administration by Nursing Council." Nursing Management (Springhouse) 18, no. 4 (April 1987): 84???85. http://dx.doi.org/10.1097/00006247-198704000-00022.

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ANDERSON, RUTH A. "Nursing Administration Education." Annual Review of Nursing Research 10, no. 1 (September 1992): 165–81. http://dx.doi.org/10.1891/0739-6686.10.1.165.

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&NA;. "NURSING ADMINISTRATION FELLOW." Nursing Administration Quarterly 9, no. 3 (1985): 98. http://dx.doi.org/10.1097/00006216-198500930-00022.

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Porter-OʼGrady, Tim. "Creative Nursing Administration." Dimensions of Critical Care Nursing 5, no. 5 (September 1986): 263. http://dx.doi.org/10.1097/00003465-198609000-00005.

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Dissertations / Theses on the topic "Nursing administration"

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Dunham-Taylor, Janne, Joseph Z. Pinczuk, and Jo-Ann Marrs. "Ethics in Nursing Administration." Digital Commons @ East Tennessee State University, 2014. https://dc.etsu.edu/etsu-works/7096.

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Book Summary: Financial Management for Nurse Managers: Merging the Heart with the Dollar, Third Edition is an essential text for nursing students and professionals because it addresses the financial management issues faced by nurse managers. Chief nursing officers and those in nurse administrator roles will also find this text valuable because of the acute focus on the financial impact of administrative and management decisions across hospitals and healthcare organizations.The Third Edition covers a broad range of topics, and demonstrates the interconnectivity between finance and other aspects of health care through evidence in healthcare finance, economics and cost accounting, budgeting, staffing effectiveness, and legal and ethical issues. The text is expertly organized and includes real-world examples to lend context to the reader.Coverage of the value-based reimbursement system is an integral component of the Third Edition. The authors emphasize the concept of giving the patient what is valued and recommend listening to patient needs, collaboration in healthcare decision-making, and shifting the role of the administrator to support care leaders. Additionally, the text has been updated to reflect the impact of the Affordable Care Act.
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Dunham-Taylor, Janne, Joseph Z. Pinczuk, Jo-Ann Marrs, and Lois W. Lowry. "Ethics in Nursing Administration." Digital Commons @ East Tennessee State University, 2009. https://dc.etsu.edu/etsu-works/7100.

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Book Summary: Completely revised and updated, the Second Edition addresses a myriad of financial concepts ranging from staffing and budgeting to measuring productivity and forecasting costs. Examples and explanations of terminology will help nurse managers successfully correspond with the financial department to implement change without negatively affecting patient care and outcomes.
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Gregg, Elizabeth Dowing. "The relationship between analgesics administration and postoperative independence /." Staten Island, N.Y. : [s.n.], 1990. http://library.wagner.edu/theses/nursing/1990/thesis_nur_1990_gregg_relat.pdf.

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Sheehy, Christine M. "Differences in Nursing Home Utilization and Clinical Outcome in Veterans Administration Nursing Home Patients." VCU Scholars Compass, 1987. https://scholarscompass.vcu.edu/etd/5520.

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Because of increasing costs and demand for nursing home care, studies are needed that can better describe the population of users and improve prediction of clinical outcomes and program requirements. The major purpose of this study was to explore the incremental and seven month outcomes of nursing home patients using the Andersen model. The design was longitudinal. Patients from one Veterans Administration (VA) hospital-based nursing home and six freestanding. VA contract community nursing homes were studied. Functional and cognitive ability were analyzed along with socioeconomic and demographic data. and utilization patterns. A second purpose was to assess associations among variables and their interaction effects in predicting outcome. A third purpose was to assess the contribution of such independent variables as case-mix and rehospitalization rates to possible cost differences evidenced by the two nursing home types. The results of this study suggest avenues for planning and allocation of resources in the two program alternatives. The Barthel Index (BI) (Mahoney & Barthel. 1965) was used to measure functional status and the Short Portable Mental Status Questionnaire (SPMSQ) (Pfeiffer. 1975) for cognitive ability. In addition to standardized measures. sociodemographic and utilization data. perceptions of health and outcomes of care were collected on all subjects. Analytical techniques included descriptive and inferential statistics. The major hypothesis was that veterans in the hospital-based versus contract statistically significant differences in characteristics and on measures of service use and clinical outcome. Findings were evaluated for policy adequacy. adherence to program intent. federal and state cost complement and other qualitative implications. Statistically significant differences were found between patients in the two settings on predisposing, enabling and need characteristics. The hospital-based NHCU patients were more likely to be married and living with someone. They also had higher incomes, more Medicare A coverage, a greater percentage of service-connected veterans and demonstrated greater limitation in functional ability than did those in contract. The predominant outcome for both groups was continued nursing home care. Statistically significant differences were also found for outcome measures. Higher income and being 76 years or older were predictive of continued nursing home residence. The type of nursing home was not significant in explaining continued care. The total number of diagnoses. age group and type of nursing home were predictive of death as an outcome. There were significantly more deaths among those 75 years or younger. among those with lower incomes and among NHCU patients. Health service utilization did not differ significantly by nursing home type. Neither group of nursing home patients demonstrated any significant improvement in functional or mental status and self-perceived health. The only differences of note were among those 75 years or less who did improve in functional ability from the third to the sixth month. The findings suggest that the two nursing home types do have different patient population profiles. However. the continued use of nursing home care by both groups indicates some lack of fit between legislative intent and actual clinical utilization.
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Gonzales, Kelly. "Safe medication administration." Diss., University of Iowa, 2011. https://ir.uiowa.edu/etd/2877.

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The purpose of this body of work was to address medication errors and safe medication administration practices in relation to practicing nurses and nursing students via several different approaches. These different approaches will be presented as three separate papers but interrelated themes. The specific purpose for each paper and the corresponding research questions were addressed individually in each chapter. The approach used in the first paper was a systematic literature search of medication administration errors and the pediatric population; five themes emerged including the incidence rate of medication administration errors, specific medications involved in medication administration errors and classification of the errors, why medication administration errors occur, medication error reporting, and interventions to reduce medication errors. The approach used in the second paper included a systematic literature review and implementation of a survey, both focusing on the assessment strategies for safe medication administration with practicing nurses and nursing students. Results of both the review and the survey indicated a lack of a comprehensive assessment of safe medication administration. The approach used in the third paper was a research study to conduct a psychometric evaluation of the Safe Medication Administration (SAM) Scale with baccalaureate nursing students. Results provided evidence of the validity and reliability of the SAM Scale. This body of work exposed a gap in nursing and demonstrates the importance of having a standardized assessment of safe medication administration with evidence of validity and reliability to demonstrate competency in this area.
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Biron, Alain. "Medication administration complexity, work interruptions, and nurses' workload as predictors of medication administration errors." Thesis, McGill University, 2009. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=66704.

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Background: The evidence to date in support of system related factors to account for medication administration errors (MAE) remains scant and inconclusive. Objective: To examine the predictive power of medication administration complexity (component and coordinative), work interruptions and nurses' workload as potential contributing factors to MAE. Design: A prospective correlational design. Setting: A medical patient care unit in a university teaching hospital Sample: A convenience sample of medication administration rounds performed by registered nurses with at least six months of professional experience. Method: Data were collected using direct observation (MAE and work interruptions), self-report measures (subjective workload, nurses' characteristics) and the Medication Administration Complexity (MAC) coding scale (component and coordinative medication complexity). Results: One hundred and two rounds were observed, during which 965 doses were administered and performed by 18 nurses. When wrong administration time errors were included, MAE rate was 28.4% whereas it decreased to 11.1% when wrong time errors were excluded. An interruption during the medication preparation phase (OR 1.596; 1.044 - 2.441) significantly increased the odds of MAE. Two significant interaction effects were found (patient demand for nursing care X overtime and patient demand for nursing care X professional experience). These interactions pointed to more negative effects of overtime and professional experience among nurses who rated the demand for nursing care as above average. Contrary to expectations, coordinative medication administration complexity significantly decreased the odds of MAE (OR 0.558; .322-.967). Including wrong administration time errors changed the cluster of predictors with component medication administration complexity (1.039; 1.016 - 1.062), and nurses' workload (1.221; 1.061 - 1.405) were significant pre
Introduction: Les résultats probants relatifs aux facteurs prédictifs des erreurs d'administration des médicaments (EAM) sont peu nombreux et non-concluants.Objectif: Examiner la complexité de l'administration (composante et coordination), les interruptions dans le processus d'administration des médicaments et la charge de travail infirmière subjective comme facteurs prédictifs des EAM.Devis: Un devis corrélationnel prospectif. Milieu: Une unité de médecine dans un centre hospitalier universitaire.Échantillon: Un échantillon de convenance formé de 102 cycles d'administration des médicaments effectués par 18 infirmières avec un minimum de six mois d'expérience professionnelle.Méthode: Les données ont été colligées par observation directe (EAM et interruptions), mesures auto-rapportées (charge de travail subjective, caractéristiques sociodémographiques) ainsi qu'avec l'échelle de la complexité de l'administration médicamenteuse (MAC coding scale).Résultats: 102 observations ont été effectuées au cours desquelles 965 doses ont été administrées par 18 infirmières. En incluant les erreurs de temps d'administration, le taux d'EAM était de 28.4% et diminua à 11.1% lorsque les erreurs de temps d'administration étaient exclues. Une interruption lors de la préparation des médicaments (OR 1.596; 1.044 - 2.441) augmente significativement le risque d'EAM. Deux interactions significatives ont été trouvées (charge de travail X temps supplémentaire et charge de travail X expérience professionnelle). Ces interactions indiquent un effet plus négatif du temps supplémentaire et de l'expérience professionnelle parmi les infirmières ayant une charge de travail supérieure à la moyenne. La complexité de coordination de l'administration de médicament, contrairement aux attentes, diminue significativement les risques d'EAM (OR 0.558; .322-.967). L'inclusion des erreurs de temp
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Johnson, Kathy F. "U. S. Nursing Students' Perceptions of Safe Medication Administration." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/3228.

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Medication errors are a global concern that may affect patients' hospital stays, patients' lives after discharge, treatment costs, and mortality rates. Understanding medication errors among nursing students may help in preventing these errors as nurses are responsible for safe medication administration. The purpose of this descriptive phenomenological study was to examine upper-level nursing students' understanding of and experiences with medication administration and patient safety. Benner's nursing theory of novice to expert and Dreyfus's model of skill acquisition comprised the conceptual framework. Research questions focused on students' perceptions of safe medication administration. Face-to-face interviews were conducted with 7 upper-level nursing students from a baccalaureate nursing program in the Southeastern U.S. utilizing convenience sampling. Colaizzi's analysis strategy was followed in determining themes and clustering data into categories. Three major themes emerged from the data that included learning curve referring to the rigor of the pharmacology course, gaining self-confidence, and reliance on preceptor. Two sub-themes were identified from the theme learning curve, which included fear of making a mistake causing harm to a patient, and appreciating the complexity of the working environment and the intricacy of the patients. Using study findings, a hybrid pharmacology and medication administration course for nursing students was developed. The course may improve nursing students' confidence in their skills and knowledge and enable them to provide a safer environment for patients. Implications for positive social change include a potential reduction in medication errors and related adverse outcomes experienced by patients and their families and by health care organization.
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Williams, Tamara Lynette. "Student Incivility and Its Impact on Nursing Faculty and the Nursing Profession." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3550.

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Incivility disrupts the learning environment for nursing students and faculty, and contributes to the national nursing shortage since many nursing faculty reportedly leave academia because of disruptive student behaviors. Academic leaders at a midwestern college of nursing are concerned by the increasing number of students engaging in uncivil behaviors and are seeking solutions. Using Clark's conceptual model, which holds that incivility can be mitigated with effective communication and engagement, this qualitative case study was designed to understand what faculty perceive as the cause of student incivility, and what actions they believe would decrease these uncivil behaviors. Data were collected from semi-structured interviews with 10 purposefully selected faculty members who met the established criteria for participation. The data were transcribed, member checked, and coded for emerging themes. Coding was completed using an open and axial coding process. Nursing faculty communicated a lack of knowledge regarding how to address student incivility, and expressed not feeling properly skilled to defuse uncivil encounters. Five major themes emerged, as follows: classroom expectations, caring culture, organizational support, orientation, and student entitlement. A 3-day professional development workshop on managing student disruptive behaviors and promoting civility within the learning environment was developed as the project outcome. Addressing incivility by learning effective ways to respond, manage, and diminish disruptive behaviors has the potential to positively impact the nursing profession, the patients in nurses' care, and the healthcare system.
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Dunham-Taylor, Janne, Joseph Z. Pinczuk, and Jo-Ann Marrs. "Ethics in Nursing Administration in Health Care Financial Management for Nurse Managers." Digital Commons @ East Tennessee State University, 2005. https://dc.etsu.edu/etsu-works/7105.

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Jones, Wilma Lee. "Leadership Styles and Nursing Satisfaction Rates." ScholarWorks, 2011. https://scholarworks.waldenu.edu/dissertations/1166.

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The purpose of this project was to translate evidence-based literature into policy and practice guidelines in order to improve leadership standards and skills among nurse managers and improve patient outcomes and the quality of care. Guided by the American Nurses Credentialing Center Magnet Model and Lewin's change theory, which sets the framework for creating exceptional nursing leaders, a literature search was conducted from studies ranging from 2010 to 2012 from several databases. Inclusion criteria were based on the presence of one or more leadership styles discussed in the articles and the impact of leadership style on nursing satisfaction. A total of 25 articles were found during the electronic search, but only 7 articles met the inclusion criteria for analysis. The results of this review revealed that transformational leadership enhanced nursing satisfaction rates, while transactional leadership and situational leadership contributed to low levels of nursing satisfaction rates. This project contributes to positive social change for nurse managers because there is limited research available that focuses on leadership styles and its implication for practice. This project will inform the work of nurse managers by illuminating the importance of leadership styles on nursing satisfaction and work environment conditions.
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Books on the topic "Nursing administration"

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H, Koff Theodore. Nursing home administration. Washington, DC: Association for Gerontology in Higher Education, 1993.

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Nursing home administration. 2nd ed. New York: Springer Pub. Co., 1992.

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Nursing home administration. 3rd ed. New York, NY: Springer Pub. Co., 1997.

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L, Rowland Beatrice, ed. Nursing administration manual. Gaithersburg, Md: Aspen Publishers, 1991.

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Nursing home administration. 4th ed. New York: Springer Pub. Co., 2003.

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Nursing home administration. New York: Springer Pub. Co., 1987.

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Psychiatric nursing administration manual. Gaithersburg, Md: Aspen Publishers, Inc., 1994.

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A, Dienemann Jacqueline, ed. Nursing administration: Managing patient care. 2nd ed. Stamford, Conn: Appleton & Lange, 1998.

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1939-, Henry Beverly, Heyden Richard, and Richardson Barbara RN, eds. International administration of nursing services. Philadelphia: Charles Press, 1989.

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Anderson, Price Sylvia, and Ervin Naomi E, eds. The professional practice of nursing administration. New York: Wiley, 1985.

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Book chapters on the topic "Nursing administration"

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Hannah, Kathryn J., Marion J. Ball, and Margaret J. A. Edwards. "Administration Applications." In Introduction to Nursing Informatics, 105–26. New York, NY: Springer New York, 1994. http://dx.doi.org/10.1007/978-1-4757-2246-8_8.

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Basavanthappa, BT. "Hospital Administration." In Nursing Administration, 505. Jaypee Brothers Medical Publishers (P) Ltd., 2009. http://dx.doi.org/10.5005/jp/books/10554_19.

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Basavanthappa, BT. "Educational Administration." In Nursing Education, 800. Jaypee Brothers Medical Publishers (P) Ltd., 2009. http://dx.doi.org/10.5005/jp/books/11100_24.

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Basavanthappa, BT. "Nursing Service Administration." In Nursing Administration, 539. Jaypee Brothers Medical Publishers (P) Ltd., 2009. http://dx.doi.org/10.5005/jp/books/10554_20.

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Basavanthappa, BT. "Discipline in Nursing." In Nursing Administration, 590. Jaypee Brothers Medical Publishers (P) Ltd., 2009. http://dx.doi.org/10.5005/jp/books/10554_21.

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Basavanthappa, BT. "Leadership in Nursing." In Nursing Administration, 35. Jaypee Brothers Medical Publishers (P) Ltd., 2009. http://dx.doi.org/10.5005/jp/books/10554_3.

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Macedo, Ana Paula, Fernando Petronilho, and João Cainé. "Nursing Information Systems." In Healthcare Administration, 959–77. IGI Global, 2015. http://dx.doi.org/10.4018/978-1-4666-6339-8.ch050.

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We have witnessed a change in the Health Information Systems (HIS) in what concerns structure, contents, and support for optimization of the resources, the best efficiency in cost control, and a better management of the quality of services rendered to the citizens. From the standpoint of reformulating the HIS, we can see an evolution in the production of information centered almost exclusively in the need of a documental proof on the care rendered by nurses to the citizens to produce information that can constitute a central resource for their clinical decision making. The authors describe the evolution of the Nursing Information Systems (NIS), reflect upon the impact of reformulation and implementation of the NIS in Portugal in the development of the nursing practice, and reflect upon the impact of the NIS reformulation in the quality of care as well as in education and training in the nursing area.
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Basavanthappa, BT. "Concepts of Administration." In Nursing Administration, 92. Jaypee Brothers Medical Publishers (P) Ltd., 2009. http://dx.doi.org/10.5005/jp/books/10554_5.

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Basavanthappa, BT. "Introduction to Nursing Profession." In Nursing Administration, 1. Jaypee Brothers Medical Publishers (P) Ltd., 2009. http://dx.doi.org/10.5005/jp/books/10554_1.

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Basavanthappa, BT. "Educational Administration in Nursing." In Nursing Administration, 654. Jaypee Brothers Medical Publishers (P) Ltd., 2009. http://dx.doi.org/10.5005/jp/books/10554_23.

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Conference papers on the topic "Nursing administration"

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Lv, Guilan, and LiXuan Huang. "Clinical effect of applying high quality nursing model in nephrology department nursing administration." In 2016 2nd International Conference on Education, Social Science, Management and Sports (ICESSMS 2016). Paris, France: Atlantis Press, 2017. http://dx.doi.org/10.2991/icessms-16.2017.25.

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Shah, H., T. Fretwell, G. Stiller, and S. Bain. "Nursing administration of Alteplase and Dornase Alfa in empyema." In ERS International Congress 2022 abstracts. European Respiratory Society, 2022. http://dx.doi.org/10.1183/13993003.congress-2022.76.

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Kraichan, Sakaorat, Panida Yowaphui, Patcharee Wangwun, Natthwut Suriya, and Theerapat Nuankaew. "The Satisfaction in the Role of Preceptor Nurse in Nursing Administration Practicum Perceived by Senior Students at Sri Mahasarakham Nursing College." In Annual Worldwide Nursing Conference. Global Science & Technology Forum (GSTF), 2014. http://dx.doi.org/10.5176/2315-4330_wnc14.47.

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Fok, SK. "The Time of First Antibiotics Administration after Sepsis Onset and Overall Sepsis Management in One Local Hospital in Hong Kong." In Annual Worldwide Nursing Conference (WNC 2017). Global Science & Technology Forum (GSTF), 2017. http://dx.doi.org/10.5176/2315-4330_wnc17.32.

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Khudhir, Karwan, Kochr Mahmood, Kochar Saleh, and Saman Adulah. "Psychosocial factors in relation to musculoskeletal disorders among nursing professionals in Raparin Administration." In 2018 International Conference on Pure and Applied Science. Koya University, 2018. http://dx.doi.org/10.14500//icpas2018.mim57.

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Lo, Ching-Kan, Sin-Sen Chang, Cheng-Hung Chuang, and Hsing-Chung Chen. "A Mobile Nursing App Applying to the Wound Care and Drug Administration of Patients." In 2015 9th International Conference on Innovative Mobile and Internet Services in Ubiquitous Computing (IMIS). IEEE, 2015. http://dx.doi.org/10.1109/imis.2015.61.

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Matias, Bruno Miguel, Jose Carlos Metrolho, and Fernando Reinaldo Ribeiro. "Software development for medication administration record in clinics and small nursing homes — A case study." In 2015 10th Iberian Conference on Information Systems and Technologies (CISTI). IEEE, 2015. http://dx.doi.org/10.1109/cisti.2015.7170494.

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Al-Azzam, Omar, and Paul Court. "Predictive Modelling of Covid-19 Stimulus Funds Paid for Nursing Home Quality Incentive Program." In 7th International Conference on Computer Science and Information Technology (CSTY 2021). Academy and Industry Research Collaboration Center (AIRCC), 2021. http://dx.doi.org/10.5121/csit.2021.112202.

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Painstaking measures should be taken to determine how federal dollars are spent. Proper justification for allocation of funds rooted in logic and fairness leads to trust and transparency. The COVID-19 pandemic has warranted rapid response by government agencies to provide vital aide to those in need. Decisions made should be evaluated in hindsight to see if they indeed achieve their objectives. In this paper, the data collected in the final four months of 2020 to determine funding for nursing home facilities via the Quality Incentive Program will be analysed using data mining techniques. The objective is to determine the relationships among numeric variables and formulae given. The dataset was assembled by the Health Resources and Services Administration. Results are given for the reader’s insight and interpretation. With the data collection and analytical process, new questions come to light. These questions should be pondered for further analysis.
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Hall, Elke, Fiona Dakin, Christine Hirsch, John Speakman, and Jon Tomas. "25 A mixed-methods study to investigate nursing attitudes towards administration of ‘as required’ prescribed symptom control medication at end of life in a hospital setting." In Accepted Oral and Poster Abstract Submissions, The Palliative Care Congress 1 Specialty: 3 Settings – home, hospice, hospital 19–20 March 2020 | Telford International Centre. British Medical Journal Publishing Group, 2020. http://dx.doi.org/10.1136/spcare-2020-pcc.46.

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Carnicer Fuentes, Concepción, Cristina Castro Yuste, José Manuel Martínez Nieto, Pablo Iglesias García de Lomas, David Abeijón Durán, Gerardo Aburruzaga García, Antonio García Domínguez, et al. "E-CUIDASALUD: ADMINISTRATIVE AND TEACHING MANAGEMENT WEB APPLICATION FOR NURSING PRACTICUM SUBJECTS." In International Conference on Education and New Learning Technologies. IATED, 2016. http://dx.doi.org/10.21125/edulearn.2016.1590.

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Reports on the topic "Nursing administration"

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Anderson, Jennifer. Understanding Male Nursing Student Perceptions of the Influence of Gender: A Qualitative Case Study Approach of Students, Faculty, and Administration in a Pacific Northwest Nursing Program. Portland State University Library, January 2000. http://dx.doi.org/10.15760/etd.1934.

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Murdock, Peter H. U.S. Army Nursing Readiness: A Field Administration of the Readiness Estimate and Deployability Index (READI) in the North Atlantic Regional Medical Command (NARMC). Fort Belvoir, VA: Defense Technical Information Center, May 2001. http://dx.doi.org/10.21236/ada420981.

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Lumpkin, Shamsie, Isaac Parrish, Austin Terrell, and Dwayne Accardo. Pain Control: Opioid vs. Nonopioid Analgesia During the Immediate Postoperative Period. University of Tennessee Health Science Center, July 2021. http://dx.doi.org/10.21007/con.dnp.2021.0008.

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Background Opioid analgesia has become the mainstay for acute pain management in the postoperative setting. However, the use of opioid medications comes with significant risks and side effects. Due to increasing numbers of prescriptions to those with chronic pain, opioid medications have become more expensive while becoming less effective due to the buildup of patient tolerance. The idea of opioid-free analgesic techniques has rarely been breached in many hospitals. Emerging research has shown that opioid-sparing approaches have resulted in lower reported pain scores across the board, as well as significant cost reductions to hospitals and insurance agencies. In addition to providing adequate pain relief, the predicted cost burden of an opioid-free or opioid-sparing approach is significantly less than traditional methods. Methods The following groups were considered in our inclusion criteria: those who speak the English language, all races and ethnicities, male or female, home medications, those who are at least 18 years of age and able to provide written informed consent, those undergoing inpatient or same-day surgical procedures. In addition, our scoping review includes the following exclusion criteria: those who are non-English speaking, those who are less than 18 years of age, those who are not undergoing surgical procedures while admitted, those who are unable to provide numeric pain score due to clinical status, those who are unable to provide written informed consent, and those who decline participation in the study. Data was extracted by one reviewer and verified by the remaining two group members. Extraction was divided as equally as possible among the 11 listed references. Discrepancies in data extraction were discussed between the article reviewer, project editor, and group leader. Results We identified nine primary sources addressing the use of ketamine as an alternative to opioid analgesia and post-operative pain control. Our findings indicate a positive correlation between perioperative ketamine administration and postoperative pain control. While this information provides insight on opioid-free analgesia, it also revealed the limited amount of research conducted in this area of practice. The strategies for several of the clinical trials limited ketamine administration to a small niche of patients. The included studies provided evidence for lower pain scores, reductions in opioid consumption, and better patient outcomes. Implications for Nursing Practice Based on the results of the studies’ randomized controlled trials and meta-analyses, the effects of ketamine are shown as an adequate analgesic alternative to opioids postoperatively. The cited resources showed that ketamine can be used as a sole agent, or combined effectively with reduced doses of opioids for multimodal therapy. There were noted limitations in some of the research articles. Not all of the cited studies were able to include definitive evidence of proper blinding techniques or randomization methods. Small sample sizes and the inclusion of specific patient populations identified within several of the studies can skew data in one direction or another; therefore, significant clinical results cannot be generalized to patient populations across the board.
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4

Harris, Gregory, Brooke Hatchell, Davelin Woodard, and Dwayne Accardo. Intraoperative Dexmedetomidine for Reduction of Postoperative Delirium in the Elderly: A Scoping Review. University of Tennessee Health Science Center, July 2021. http://dx.doi.org/10.21007/con.dnp.2021.0010.

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Background/Purpose: Post-operative delirium leads to significant morbidity in elderly patients, yet there is no regimen to prevent POD. Opioid use in the elderly surgical population is of the most significant risk factors for developing POD. The purpose of this scoping review is to recognize that Dexmedetomidine mitigates cognitive dysfunction secondary to acute pain and the use of narcotic analgesia by decreasing the amount of norepinephrine (an excitatory neurotransmitter) released during times of stress. This mechanism of action also provides analgesia through decreased perception and modulation of pain. Methods: The authors developed eligibility criteria for inclusion of articles and performed a systematic search of several databases. Each of the authors initially selected five articles for inclusion in the scoping review. We created annotated literature tables for easy screening by co-authors. After reviewing the annotated literature table four articles were excluded, leaving 11 articles for inclusion in the scoping review. There were six level I meta-analysis/systematic reviews, four level II randomized clinical trials, and one level IV qualitative research article. Next, we created a data-charting form on Microsoft Word for extraction of data items and synthesis of results. Results: Two of the studies found no significant difference in POD between dexmedetomidine groups and control groups. The nine remaining studies noted decreases in the rate, duration, and risk of POD in the groups receiving dexmedetomidine either intraoperatively or postoperatively. Multiple studies found secondary benefits in addition to decreased POD, such as a reduction of tachycardia, hypertension, stroke, hypoxemia, and narcotic use. One study, however, found that the incidence of hypotension and bradycardia were increased among the elderly population. Implications for Nursing Practice: Surgery is a tremendous stressor in any age group, but especially the elderly population. It has been shown postoperative delirium occurs in 17-61% of major surgery procedures with 30-40% of the cases assumed to be preventable. Opioid administration in the elderly surgical population is one of the most significant risk factors for developing POD. With anesthesia practice already leaning towards opioid-free and opioid-limited anesthetic, the incorporation of dexmedetomidine could prove to be a valuable resource in both reducing opioid use and POD in the elderly surgical population. Although more research is needed, the current evidence is promising.
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