Sue & Bill Gross School of Nursing

Background: Mechanically ventilated patients in the ICU are at a high risk for ventilator-associated pneumonia (VAP), and the rate of this hospital-acquired infection (HAI) is problematic. Nursing interventions utilize evidence-based practice (EBP) VAP prevention guidelines to decrease the incidence. The purpose of this paper is to examine the effects of staff education on the reduction of VAP in the critical care setting.

Methods: Literature search was performed on two databases, CINAHL and PubMed. Search results were narrowed based on type of research article, relevance, and publication date, and eventually three studies were chosen.  

Results: In two of the studies, VAP incidence was shown to have decreased after staff education and one study had insignificant results, although there was a trend towards decreased VAP incidence. Length of stay significantly decreased post-intervention in two studies. Nurse adherence/concordance significantly increased in all studies.

Conclusions: These findings show that staff education may decrease VAP incidence in ICUs, but further research needs to be performed to confirm these findings, as well as to determine the best form of education. Nurses are the primary individuals to prevent mechanically ventilated patients from acquiring VAP, and thus the next step would be focusing on how to improve long-term nurse adherence to preventative interventions and how to implement them into bedside practice.

Background: Autism spectrum disorder (ASD) is diagnosed in early childhood and affects 1 in 68 children in the United States. ASD often creates deficits in social functioning making it difficult for children with ASD to socialize and communicate with others.

Purpose: The purpose of this review paper is to examine the effectiveness of therapeutic horseback riding (THR) on communication and social skills in children with ASD.

Methods: Articles were selected from the databases CINAHL and PubMed and were published within the last 10 years in the United States and Europe. Search terms included ASD, children, and THR. Studies with samples sizes of ten or less were excluded.

Results: Inconsistent results were found for two of the studies that used the Social Responsiveness Scale; one study found statistically significant results for improved social motivation when compared to the control group (p = .038) while another study found a significant improvement for social cognition compared to the control group (p= 0.05). The remaining outcomes tested amongst the studies were not significant.

Conclusion: Current research does not fully support the efficacy of THR on communication and social skills for children with ASD. Therefore nurses do not have enough evidence to recommended this approach to families that have a child with ASD. Future studies should be conducted using larger sample sizes so the ASD population is well represented. With more research, the findings will hopefully serve to facilitate the assimilation of this population into society.

Dementia, a progressive cognitive impairment, is the fifth leading cause of death in California with no effective treatments. This disease not only affects those diagnosed but also affects their family caregivers who experience intense emotional and physical strain. Despite this immense stress, there is an insufficient number of interventions focused on the well-being of these family caregivers. The purpose of this pilot study is to provide a mindfulness-based stress reduction intervention to family caregivers. Trained research assistants visited participants’ homes weekly for a month and introduced mindfulness techniques (i.e., deep breathing exercises, caregiving education). A modified version of the Positive Affect (PA) and Negative Affect (NA) Scale was used to measure caregivers’ emotions before and after the intervention. Twenty participants were recruited from Vietnamese and Korean communities, an Alzheimer’s research center, and an academic medical center. The mean age of family caregiver participants was 62.5(SD=4.98) ranging from 26 to 82 years old, of which 19 (95%) participants were females and 10 (50%) were spouses. Ethnic backgrounds of participants varied: 9 Vietnamese, 7 Korean, 3 Caucasian, and 1 African American. The stages of dementia included those in the early (35%), middle (50%), and late-stage (15%) stages. Our findings showed a trend of increase in positive affect (Pre-intervention=16.25 (SD=4.67), Post-intervention=17.45 (SD=4.05), t(df)=-1.45(19), p=.163) and decrease in negative affect, (Pre-intervention=5.9 (SD=2.97), Post-intervention = 4.95 (SD=1.28), t(df)=1.57(19), p=.133). Self-rated happiness displayed slight improvement (Pre-intervention=4.10 (SD=.912), Post-intervention=4.35 (SD=.745), t(df)=-1.23(19), p=.234). The mindfulness intervention showed the potential to improve dementia family caregivers’ emotional wellbeing.

Introduction: Infants in the NICU often suffer from physiologic stress related to bradycardia, apneic spells, and oxygen desaturations. This review analyzes the effect of KC on the frequency of cardiopulmonary events.

Methods: Databases utilized include PubMed, Google Scholar, and CINAHL. These papers were selected based on their publication in the last ten years, and focus on examining effects of skin-to-skin care on the NICU infant as measured by the infant’s physiological stability.

Results: All three studies showed that infants in the treatment groups had a significantly decrease in bradycardic events compared to control group. Two studies found that infants in the treatment group had significantly fewer oxygen desaturations while being held skin-to-skin versus the time they spent in the warmer.

Discussion: The studies used high fidelity of intervention, and two of the three used randomized controlled trails designs. The small sample size of the studies was a weakness and warrants further research.

Conclusion: Nurses should develop policies for increased encouragement for kangaroo care for preterm infants in NICUs.

Introduction: The Nurse Family Partnership (NFP) attempts to combat the lack of resources and knowledge in high-risk families and women who are pregnant for the first time. This paper assesses the effect of the NFP on child development.

 Methods: Google Scholar, CINAHL, PubMed, and Trip were used to conduct a literature review. Articles chosen were randomized control trials and involved implementation of the NFP with a longitudinal follow-up of the children.

 Results: Two out of three studies demonstrated that the NFP positively affected academic success of the children; two out of three studies demonstrated that children who received the intervention had less emotional/behavior issues.

 Discussion: All studies were randomized control trials without dropout. Studies utilizing objective data had more accurate results than those utilizing self-report. There was a discontinuity of care in one study and no way to measure visit content and conduct in any of the studies.

 Conclusion: Results were most pronounced in low-resource and school-age children. Nurses should recruit high-risk clients and advocate for programs such as the NFP. Further research should strive to standardize measurements, include additional follow-ups, and consider pregnancy and parental outcomes.

Background: Type 2 diabetes is a growing problem across the world. Diabetes leads to increased levels of hemoglobin A1c (A1C), and if left untreated, can lead to further chronic disease. This review examines the effectiveness of group-based diabetes self-management education (DSME) on lowering A1C levels and increasing diabetes knowledge.

Methods: Databases used for this review include PubMed, CINAHL, Google Scholar, and Web of Science. The three studies chosen for this review include two randomized controlled trials (RCT's) and one quasi-experimental study, which were peer-reviewed and published in the past 5 years.

Results: All studies demonstrated a slight decrease in A1C levels; however, one study found a significant decrease between pre-and-post intervention (p<0.0001). The two RCT's also reported a significant increase in diabetes knowledge.

Discussion: The strengths found across all studies were the study design used, fidelity of the intervention, and validity of the methods used to measure the primary outcome. All three studies took a different DSME approach; however, their end-goal was the same as they measured similar outcomes.

Conclusion: DSME is a feasible approach in improving diabetes education and attempting to reduce A1C levels. Further research is needed to develop a standardized curriculum that maximizes the benefits of DSME.

Approximately 3% of all pregnancies are affected by fetal anomalies; consequently, mothers face the difficult decision of whether to continue or terminate their pregnancy. An estimated 47% – 90% of women choose to terminate these pregnancies. Induction of labor in cases of fetal demise is thought of as less controversial than induction termination, but nurses may resist and even refuse to care for women in these cases.

Parent-infant attachment is the bond between a child and a parent with its purpose being to make the child feel safe, secure, and protected. The environment of the NICU is not optimal for developing this attachment as the parents and baby have to be separated. Much research has been done on methods to improve the issue. Two interventions that can improve attachment include: Better nurse-parent communication and teaching, and skin-to-skin contact.

Depression is a prominent cause of global morbidity, and one of the most common medical conditions during pregnancy. Prenatal depression can lead to detrimental outcomes including preterm birth, low birth weight, and postpartum depression. Screening for depression is recommended at least once during the perinatal period. However, even after a diagnosis of depression, several barriers to treatment exist, including cost and patient opposition to treatment. This literature review examines the effectiveness of yoga practice in pregnant women who are depressed or have depressive symptoms. Five research articles published within the last five years were selected that support a yoga practice innovation for prenatal depression management. The utility of yoga is demonstrated in these articles in clinically depressed pregnant women and pregnant women with symptoms of depression or anxiety. A yoga practice protocol shown to be effective in prenatal depression was replicated, and based on that protocol, this paper proposes that clinics that care for depressed pregnant women employ an evidence-based yoga intervention spanning twelve weeks with a minimum of twice weekly yoga practice. Research has shown that yoga practice is safe, efficacious, practical, and decreases prenatal depressive symptoms. Future research should include the diverse demographics of socioeconomic status, prenatal care access, and ethnicity of depressed pregnant women to strengthen the data supporting yoga practice for prenatal depression management.

Faculty advisor: Lorraine Evangelista, Ph.D.  l.evangelista@uci.edu - Program in Nursing Science

Sleep deprivation is a common problem in the intensive care unit because it can increase rates of delirium, impede proper recovery, lead to longer hospital stays, and increase health care costs. This study aims to review three randomized controlled trials that observe the effect of noise reduction methods in improving sleep quality among intensive care patients. One study compared rates of delirium among those use earplugs and those who do not. Two other studies found that interventions such as earplugs, eye masks, and melatonin have proven to improve sleep quality. While interventions such as earplugs may be uncomfortable for some patients, it is reasonable it to at least offer these products to those who may want it. This can in turn improve patient satisfaction rates, decrease hospital length of stays and reduce healthcare costs. Moreover, these interventions are safe, cost effective, and easy to implement.

Faculty advisor: Jill P Berg, Ph.D., Professor Emeritus (jpberg@uci.edu) - Program in Nursing Science