The results of this study will help to determine educational needs and clinical practice of CAM therapies with CNSs at this academic medical center. The survey used and the research results from this study can be a template for other CNSs to use to begin to address this topic of CAM use in other hospitals and clinical settings. This survey could be used to explore CAM use by patients in specialty areas for practice enhancement.

A closed-book, multiple-choice examination following this article tests your under standing of the following objectives:1. Describe the impact of ethical conflict in the intensive care unit (ICU) for patients, families, and health care workers. 2. Describe risk factors and early warning signs of potential ethical conflicts with ICU patients. 3. Explain key results of ethical risk factor screening for critical care nurses. Results Older patients with multiple comorbid conditions and aggressive treatments were frequently assessed to be at risk for ethical conflicts. Nurses who witnessed patients' suffering and deterioration were likely to initiate the screening process. The most prominent family risk factors included unrealistic expectations and adamancy about treatment. The most prominent early indicators were signs of patients' suffering, unrealistic expectations, and providers' own moral distress. High-risk situations averaged a greater number of risk factors and early indicators than did medium-and low-risk situations. Certain risk factors featured prominently in high-risk situations. Conclusions A phenomenon of shared suffering emerged from the study and signifies the importance of relational strategies such as routine family conferences and ethics consultation.

Miami J and Philadelphia collars restricted CROM to the greatest extent. Miami J and Miami J/Occian back had the lowest levels of mandibular and occipital pressure; these collars may markedly reduce the risk of occipital pressure ulcers without compromising immobilization.

In the neurosurgery patient population, one of the most frequent complications is postoperative nausea and vomiting (PONV). The purpose of this predictive correlational study was to examine the incidence and predictors of PONV in a cohort of 519 neurosurgery patients undergoing elective spinal and intracranial procedures. Patients were interviewed, and their medical records were reviewed every 24 hours for up to 72 hours postoperatively to identify risk factors for PONV development. After summarizing univariate associations, a multivariable logistic regression model for each outcome was developed using forward and backward stepwise selection, with the p value for a variable to enter or leave the model set to .05. Women, especially those who were younger and with a history of PONV, were most likely to have PONV. In addition, those undergoing craniotomy, particularly infratentorial craniotomy, were more likely to have PONV compared with patients undergoing spine surgery. This study provides a foundation for nursing and interdisciplinary intervention studies aimed at reducing this postoperative symptom in the most susceptible patients.

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