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Here is my second topic: Research problem: With the rise of diabetes, many patients in the intensive care unit are on intensive insulin therapy requiring hourly, sometimes every 15 minute, glucose checks. Glucose checks at most facilities consist of pricking the patient’s fingers. While insulin infusions are very effective in decreasing dangerous glucose levels, patients still complain of not only lack of sleep but also pain caused by repetitive finger pricking. Findings have shown repetitive finger sticking consequences to include development of massive scarring, callous formations, and loss of sensibility (Heinemann, 2008). In addition, potential for measurement errors, increased risk of infection, and excess workload on nurses were also shown as negative factors to this type of glucose monitoring (Weiss & Lazar, 2007). Numerous studies exist on continuous glucose monitoring of type I diabetic patients; however, few studies have been conducted on the effectiveness of continuous glucose monitoring of patients subjected to intensive insulin therapy in the intensive care unit. Purpose: The purpose of this study is to examine the effectiveness and practicality of continuous glucose monitoring in patients receiving intensive insulin therapy in the intensive care unit. Type of study: Quantitative Method: Glucose results obtained from both finger-pricks and glucose sensors will be compared for accuracy and a likert scale will be used to reveal patient satisfaction????

I am in need of your opinions! :) I am currently working towards my master's degree and trying to decide which topic to do my review of literature on which will eventually evolve into my thesis/capstone project. I am opened to suggestions...no hurt feelings here! Thank you! Topic of interest: Music therapy in ventilated patients in the adult intensive care unit. Problem: Restlessness of ventilated patients is normally controlled through sedation and/or anxiolytics. However, this practice often leads to difficulties in weaning due to patient's inability of taking adequate spontaneous breaths. Prolonged ventilation is not only hazardous for the patient but also costly. Many studies have been performed on music therapy use in the neonatal unit; however, few studies have been performed on the use of this intervention in the adult intensive care unit (Austin, D., 2010; Lee O., Chung Y., Chan M. & Chan W., 2005; ). Purpose: To study the effects of music therapy on decreasing anxiety and restlessness in ventilated patients in the adult intensive care unit. Type of study: quantitative study reviewing amount of sedation used and physiological signs during exposure to music therapy Hypothesis: Ventilated patients in the adult intensive care unit demonstrate lower levels of anxiety and restlessness requiring less sedation when exposed to music therapy. Austin, D. (2010). The psychophysiological effects of music therapy in intensive care units. Paediatric Nursing, 22(3), 14-20. Retrieved from EBSCOhost. Lee, O., Chung, Y., Chan, M., & Chan, W. (2005). Intensive care music and its effect on the physiological responses and anxiety levels of patients receiving mechanical ventilation: a pilot study. Journal of Clinical Nursing,14(5), 609-620. Retrieved from EBSCOhost. My first choice was the effectiveness of continuous glucose monitoring in patients requiring intensive insulin therapy in the intensive care unit. However, I have been told that I "could" do this, but the feasibility would be difficult. It would be awesome to do though! :)

Hello there Classic dame! Thank you so very much for the information! I did not realize that European meters were different...I have only just scratched the surface of my literature review, but I am determined to stay on topic despite some saying it will be too difficult to do or a waste of time..I guess I am but a few who are curious about alternative methods. I am finding more and more literature every day, so this looks promising!

NtannRN..thanks for the reply! There is little research on non-invasive monitoring...most are still waiting for approval. A student at baylor university has invented a monitor that uses infrared, but is in the process of downsizing for practicality. Most studies have been used on less invasive monitoring, such as sensors which do have a needle tip but is placed in the patient and left there for up to 7 days. These sensors have been used in type I DM for a while and are great! So, why not in the ICU. Findings have shown repetitive finger sticking consequences to include development of massive scarring, callous formations, and loss of sensibility (Heinemann, 2008). In addition, potential for measurement errors, increased risk of infection, and excess workload on nurses were also shown as negative factors to this type of glucose monitoring (Weiss & Lazar, 2007). Heinemann, L. (2008). Finger pricking and pain: a never ending story. Journal of Diabetes Science and Technology,2(5), 919–921. Weiss, R. & Lazar I. (2007). The need for continuous blood glucose monitoring in the intensive care unit. Journal of Diabetes Science and Technology,2(3), 412–414. BiffBradford, I don't think you are changing the subject at all....At the previous hospital I worked, we had arterial lines all the time and would draw everything from them; however, at my present place of work, we hardly see any arterial lines, and managers want use to prick fingers for q1h checks on all insulin drips...I know... crazy! This is why I am curious to know what others are doing and researching possible alternatives. :)

Thank you for the reply! Hopefully, more will chime in! :)

Hello there! I would love your expertise!! I will be doing a study abroad in London this April for my Master's program here in the US. I would love to do a comparative, quantitative study regarding glucose monitoring in the UK versus US pertaining to intensive insulin therapy. I am especially curious about continuous monitoring, but am having a difficult time finding enough research/articles. Where I work, we use the Atlanta protocol for our insulin infusions which require hourly glucose checks (sometimes 15 min) then a set calculation to determine any rate changes that are needed. Hospital policies frown upon using blood from any lines..be it peripheral, central, or arterial, even in closed systems, so we are finger-pricking only. I would love to find any alternative ways to collect an accurate measurement that would be practical for use in the hospital setting. 1. Do you have any experience with non-invasive glucose monitoring? Likes/dislikes? 2. Do you know where I can find a list of other types of protocols being used, like the Atlanta protocol, for insulin infusions? 3. What types of issues have you noticed with insulin infusions, besides multiple "on/off" use of infusions? 4. Can you recommend any websites to review? 5. Do you believe a sensor would be too costly for hospital stays? And do know where I might be able to find information regarding costs? I know....lots of questions..I apologize, but it seems after my hours and days of searching ebsco/pubmed..I am still at a lost for some information....I may have to unfortunately change my topic to search... Thank you so much for your assistance!

Hmmmm....no responses? Well then...anyone there use continuous insulin infusions at all? What type of calculations are you using to make rate changes? I am guessing you are doing finger pricks?

Thanks for your reply...let me clarify myself...It is against policy to use any lines, be it central, peripheral, or arterial...However, when questioned about the research to back their policy..no one responds. I do understand some patients can and do sleep through finger pricking, and I have done this many a time believe me...but wouldn't it be wonderful to not have to subject them to this? Just curious if anyone out there is using or have ever used any type of continuous glucose monitor-invasive or non-invasive..ie sensors...

Hello there! I will be doing a study abroad in London this April for my Master's program here in the US. I would love to do a comparative, quantitative study regarding glucose monitoring in the UK versus US pertaining to intensive insulin therapy. Where I work, we use the Atlanta protocol for our insulin infusions which require hourly glucose checks (sometimes 15 min) then a set calculation to determine any rate changes that are needed. Problems related to this is: patient compliance/discomfort related to painful, frequent finger pricks, lack of sleep due to frequency of pricks and nursing rounds. Some patients are placed on these infusions for 2-3 days! Hospital policies also frown upon not using peripheral blood, so no blood from central lines or arterial lines can be used, even in closed systems...I am curious about your procedures/protocols: 1. Do you have non-invasive glucose monitoring available? 2. Do you use a scale or calculation with your continuous insulin infusions? And how does it work? 3. How long are your patients on insulin infusions? 4. Do you use peripheral sticks only or are you able to obtain glucose from central lines? 5. Have you any related patient problems that I have not already mentioned? Thank you so much for your assistance! If it takes me awhile to reply, I apologize...I am working full-time, attending grad school part-time, and keeping up with three children and a hubby! :)

Hello there! I will be doing a study abroad in London this April for my Master's program here in the US. I would love to do a comparative, quantitative study regarding glucose monitoring in the UK versus US pertaining to intensive insulin therapy. Where I work, we use the Atlanta protocol for our insulin infusions which require hourly glucose checks (sometimes 15 min) then a set calculation to determine any rate changes that are needed. Problems related to this is: patient compliance/discomfort related to painful, frequent finger pricks, lack of sleep due to frequency of pricks and nursing rounds. Some patients are placed on these infusions for 2-3 days! Hospital policies also frown upon not using peripheral blood, so no blood from central lines or arterial lines can be used, even in closed systems...I am curious about your procedures/protocols: 1. Do you have non-invasive glucose monitoring available? 2. Do you use a scale or calculation with your continuous insulin infusions? And how does it work? 3. How often do you check the glucose on insulin infusions? 4. Do you use peripheral sticks only or are you able to obtain glucose from central lines, meaning arterial lines? 5. Have you any related patient problems that I have not already mentioned? Thank you so much for your assistance! I must say, I am so excited about going to London! My husband will be joining me a few days before my study to celebrate our 12th anniversary! And I get to be there for the royal wedding!! :redpinkhe

Great responses! Thank you everyone! I am excited to read all the ipad responses. I hope to get one soon...with a keyboard!! :) And Dixiecup...I will definitely need sleep between studying..I will be really pushing it working nightshift full-time and school part-time while caring for my kids: 19m and 3yo (looking into daycare). Thankfully, I have a very helpful husband and 9yo daughter! Now, hope my finances for school come through all the way! Thank you again for all the advice!

Hey everyone!! I will be starting a FNP/ENP program this fall and am curious....what did you need the most during grad school? Bought a new laptop, looking into getting an IPAD (mostly because of want not need). Anything that really helped during your graduate program: types of phone, books, iapplications, etc. Thanks for the info!

Thanks for the reply....I wish I could change the format..unfortunately, they have specific requirements....I'm still trying to rearrange.. thanks again

Hi all! Just another critical care nurse seeking entrance into a FNP program. I would love to know any opinions on my goal statement. It is suppose to be 3 pages long, and I am having difficulty shortening it. I am just one short paragraph into the fourth page. The last paragraph was the only way I could think of adding the mission statement and ending the essay without sounding abrupt. I normally have no problems with writing, but I guess my nerves are blocking the oxygen supply to my brain cells.. Thanks for the help! Also...does it sound too personal? Statement of Purpose Caring for others became second nature for me at an early age. During my childhood years, I was handed the responsibility of caring for my terminally ill father. I was not the typical child excited about missing a school day. I was the atypical child who looked forward to missing school to assist her father to his monthly visits to the veteran's hospital to discuss his health. I was the curious child peeking over her father's shoulders to look at blood test results, radiographic images, and endoscopic videos, attempting to make sense of it all. Of course, caring for my father had its difficult moments. He required constant encouragement to remain compliant in his prescribed diet and medications, and he needed gentle reminders about his physical limitations. He was a strong-willed man who continued to work in the early stages of his illness regardless of the consequences in order to provide for our family. He would tell me, "You always try your best no matter what and you never let anyone, not even doctors, tell you you can't do anything you want to do!" Years later, my father, still miraculously alive but very ill, sat by my side in a birthing room for 22 hours. He meticulously wiped my forehead with cold washcloths and attempted to feed me ice chips, which I secretly wiped most away from my lap. His wide eyes and shaky hands were evidence of his intake of medication on an empty stomach. His persistent loving care regardless of his own anguish touched my soul. I just did not have the heart to tell him that I could not eat another ice chip, and I was tired of the washcloths on my forehead. Although I suggested multiple times for him to eat and take a nap, he was just too excited to see his first grandchild. A month later, sitting in the funeral parlor with my daughter and husband, I relived the moments I had spent with my father in my mind. As talkative as my father was, he never spoke of feelings or his illness. I wondered if he ever accepted his diagnosis, if he ever spoke of his fears or concerns to anyone. I wondered if he was afraid or relieved in the end. I wondered if anyone held his hand as he was dying since family was not allowed in his room at the time. Four years later, I graduated from the ------. As I walked upon the stage to receive my degree in nursing, I looked towards my family and imagined my father's presence. Never before had I felt so accomplished and yet so heartbroken. I vowed to myself I would follow in my father's footsteps and give my patients the type of kind, unselfish care he had shown to me. I would be persistent in providing quality support. I would hold my patients' hands and tell them I am here for them. I would take the time to listen to their concerns and complaints and attempt to comfort them as best as I could just as he had tried his best to comfort me. As a critical care flex nurse for ------Health, I have the unique opportunity to make a difference by caring for a vast range of patients while working in multiple areas of nursing throughout three separate facilities. At times, I even have the pleasure of following my patients throughout their entire hospital stay. I cannot even begin to express how rewarding it is to witness a patient's transformation towards health and to participate in that transformation. I chose ----- Health because of their focus on family-centered care. I have held many hands and listened to many stories; witnessed births and deaths; shared many laughs and cried many tears. I have not developed a love of just one specialty but of caring for all people of all ages both spiritually and physically. It is through these experiences I have developed a desire to become a family nurse practitioner. With the escalation of chronic illnesses and co-morbidities along with longer life expectancies, the need for early health promotion and disease prevention in families across the life span is even greater. Having time to listen to a patient's history and concerns, much less the worries of concerned family members is becoming more difficult for physicians to achieve due to a number of issues, including high patient loads and inadequate staff support. Family nurse practitioners are an excellent resource to closing these gaps to quality healthcare. As an advanced practitioner, I would have time to build trusting relationships with families, educate them on proper administration of medicine, and help them overcome any learning or related health barriers. I would have more time to listen to concerns and to assist in providing a solution by working collaboratively with other healthcare providers. My goal is not only to provide healthcare to families in a primary care setting but also to offer counseling and teaching in areas of health promotion, chronic disease management, and disease prevention. I want to empower families to take control of their own health. I also plan to assist in eliminating health disparities by obtaining a position in a community clinic serving vulnerable families and by volunteering my services to those in underserved countries. Lastly, my long term goal is to obtain a doctorate in nursing in order to deliver better patient outcomes and to be equipped for future healthcare changes. My nursing and life encounters have well prepared me for the demands involved in becoming a family nurse practitioner. I have the leadership, communication, and critical thinking skills required to be successful. I have learned how to work independently as well as with a multidisciplinary team of health professionals. My communication skills have grown immensely since I am interacting with a more diverse patient population and different nursing and medical staff as well. Being able to quickly adapt to unfamiliar or crisis situations and the ability to modify nursing implications to meet current patient needs are two important skills I have mastered. I also developed time management skills at an early age: juggling work, family, and school while maintaining a high grade point average. It was not a difficult choice on where I wanted to continue my professional goals. ______ graduate program is my first choice. The undergraduate program well prepared me to be competent in the nursing profession. I have the same expectations the graduate program will also equip me with the tools I need to successfully advance my career. Professors at _____ are examples of true nursing leadership. Their love for the nursing profession is revealed through lectures, guidance, research, and national recognition in their areas of expertise. Based on the observance of passion from professors of past instruction, I look forward to embracing the challenges my classes may offer and expanding my intellectual curiosity.

Thank you! cmo421 I actually thought about doing that. I'm applying to the same university I received my bachelor's. The last paragraph was the only way I could think of ending the essay and reinstating their mission at the same time without having the paper end so abruptly...Plus I really wanted them to know how much I respect them as scholars and nurses. Thank you for the compliment! I needed a boost. I have been stressing out about this whole thing!!