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Poh PF, Carey MC, Manning JC, Lee JH, Latour JM. Parental emotional, social and transitional health in the first 6 months after childhood critical illness: A longitudinal qualitative study. J Adv Nurs 2024. [PMID: 38922972 DOI: 10.1111/jan.16288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 12/07/2023] [Accepted: 06/06/2024] [Indexed: 06/28/2024]
Abstract
AIM To explore the experiences and support needs of parents in the first 6 months after paediatric critical care. DESIGN Longitudinal qualitative design. METHODS Sequential semi-structured qualitative interviews were conducted with a sample of 28 parents in succession at 1 month and at 6 months (n = 22) after their child's discharge from paediatric critical care using purposive sampling. Data were analysed using the adapted five-stage framework analysis. RESULTS Data were developed into eight synthesized themes, three domains and an overarching theme: Regaining Normalcy. Families of children requiring medical treatment at 6 months showed signs of adaption to daily care routines. The two domains were Parental Emotional Health and Parental Social Health. Parental Transitional Health, a third domain, was added to the Post Intensive Care Syndrome-paediatric framework. Parents were forward-looking and discussed emotional health, relating to current caregiving issues. Emotional attention was related to present challenges and concerns about current health and possible readmission to the hospital. In terms of Parental Social Health, families isolated themselves for infection control while remaining connected with families using chat applications. Parents were selective to whom they allowed access to their lives. The impact of parental transitional health was evident and emphasized the daily challenges associated with integration back to home life. Flexible work arrangements allowed working parents to support caregiving needs in the first 6 months after discharge. CONCLUSION In the first 6 months after paediatric critical illness, most families reported having moved past the experiences while having provoking memories of the admission period. Parents viewed the point of normalcy as child returned to school or when all medications were discontinued. Extension of transitional support can facilitate discharge experiences between paediatric critical care and normalcy. The findings highlight the importance of understanding the medium- and longer-term impact of paediatric critical care. IMPACT What problem did the study address? ○ Limited understanding of long-term parental experiences and support needs after PICU discharge. What were the main findings? ○ Most families regained normalcy when child returns to school or when medications were discontinued. Some families continued to show signs of adaptations at 6 months after PICU discharge. Where and on whom did the research have an impact? ○ The research has an impact on improving the understanding of long-term parental experiences and support needs after PICU discharge, informing clinical practice, guiding policy development and shaping parental support programs. REPORTING METHOD We reported this study using the COREQ guidelines. PATIENT OR PUBLIC CONTRIBUTION Prior to confirming the interview guide, three parents of critically ill children actively participated by reviewing and providing feedback on its content. They provided suggestions to refine the wording and ensure clarity to enhance the participants' understanding. By including the perspectives of these parents, we aimed to improve the overall quality and relevance of the interview guide.
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Affiliation(s)
- Pei-Fen Poh
- Division of Nursing, KK Women's and Children's Hospital, Singapore, Singapore
- School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth, UK
- Paediatrics Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore
| | - Matthew C Carey
- School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Joseph C Manning
- Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
- School of Healthcare, College of Life Sciences, University of Leicester, Leicester, UK
| | - Jan Hau Lee
- Paediatrics Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore
- Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore, Singapore
| | - Jos M Latour
- School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth, UK
- Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, China
- School of Nursing, Fudan University, Shanghai, China
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Do Research Prioritization Exercises Reduce Research Waste? Pediatr Crit Care Med 2022; 23:956-958. [PMID: 36326464 DOI: 10.1097/pcc.0000000000003058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Abstract
OBJECTIVES To identify nursing research priorities in pediatric critical care in Asia. DESIGN We conducted a modified three-round eDelphi survey with pediatric critical care nurses in Asia. The eDelphi technique has been extensively used within health research to achieve a common viewpoint from experts using questionnaires to gather research priorities. In round 1, participants were asked to list three to five research topics that they deemed important. These topics were thematically analyzed and categorized into a questionnaire. Participants rated the research topics in round 2 on a 6-point scale (1 = not important to 6 = extremely important). In round 3, the same questionnaire was used with addition of the calculated mean scores from round 2 for each topic. Research topics ranked among the top 10 were considered extremely important. SETTINGS Twenty-two PICUs in eight Asian countries. SUBJECTS Clinical nurses, managers, educators, and researchers. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS In round 1, 146 PICU nurses across eight countries provided 520 research topics. Topics from round 1 were categorized into seven domains with 52 research topics. Prioritized research topics included early recognition of patient deterioration (mean 5.58 ± 0.61), prevention of healthcare-associated infections (mean 5.47 ± 0.70), and interventions to reduce compassion fatigue (mean 5.45 ± 0.80). The top three research domains were end-of-life care (mean 5.34 ± 0.68), professionalism (mean 5.34 ± 0.69), and management of pain, sedation, and delirium (5.32 ± 0.72). CONCLUSIONS This first PICU nursing research prioritization exercise within Asia identified key nursing research themes that should be prioritized and provide a framework for future collaborative studies.
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Mörelius E, Munns A, Smith S, Nelson HJ, McKenzie A, Ferullo J, Gill FJ. Pediatric and child health nursing: A three-phase research priority setting study in Western Australia. J Pediatr Nurs 2022; 63:39-45. [PMID: 34973465 DOI: 10.1016/j.pedn.2021.12.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 11/22/2021] [Accepted: 12/16/2021] [Indexed: 01/12/2023]
Abstract
PURPOSE Priority settings are important to plan and direct future research. The aim of this study was to identify the top ten pediatric and child health nursing research priorities from the perspectives of consumers, community, and healthcare professionals in Western Australia. DESIGN AND METHODS This study used an adapted James Lind Alliance Priority Setting Partnership design with three phases. 1) A planning workshop to inform a survey. 2) A survey using five open-ended-questions distributed between October 2020 and January 2021 through social media and healthcare professionals' emails. Responders' statements were analyzed with content analysis. 3) A consensus workshop to finalize and rank the themes. RESULTS The planning workshop participants (n = 25) identified gaps such as community child healthcare and confirmed lack of consumer engagement in previous studies. The survey responses (n = 232) generated 911 statements analyzed into 19 themes. The consensus workshop participants (n = 19) merged and added themes, resulting in 16 final themes. The top three ranked themes were: 'access to service', 'mental health and psychological wellbeing', and 'communication'. CONCLUSIONS The research themes are necessarily broad to capture the wide range of issues raised, reflecting the scope of pediatric and child health nursing. PRACTICE IMPLICATIONS The priorities will inform future research to be directed to areas of priority for stakeholders who have often not had a say in setting the research agenda.
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Affiliation(s)
- Evalotte Mörelius
- Child and Adolescent Health Service, Nedlands, WA, Australia; School of Nursing and Midwifery, Edith Cowan University, WA, Australia.
| | - Ailsa Munns
- Child and Adolescent Health Service, Nedlands, WA, Australia; Curtin School of Nursing, Curtin University, WA, Australia
| | - Stephanie Smith
- Child and Adolescent Health Service, Nedlands, WA, Australia; School of Nursing and Midwifery, Edith Cowan University, WA, Australia
| | - Helen J Nelson
- Child and Adolescent Health Service, Nedlands, WA, Australia
| | - Anne McKenzie
- Community Engagement Telethon Kids Institute, Nedlands, WA, Australia
| | - Jade Ferullo
- Child and Adolescent Health Service, Nedlands, WA, Australia
| | - Fenella J Gill
- Child and Adolescent Health Service, Nedlands, WA, Australia; Curtin School of Nursing, Curtin University, WA, Australia
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Perrin BM, Raspovic A, Williams CM, Twigg SM, Golledge J, Hamilton EJ, Crawford A, Hargreaves C, van Netten JJ, Purcell N, Lazzarini PA. Establishing the national top 10 priority research questions to improve diabetes-related foot health and disease: a Delphi study of Australian stakeholders. BMJ Open Diabetes Res Care 2021; 9:e002570. [PMID: 34764140 PMCID: PMC8587617 DOI: 10.1136/bmjdrc-2021-002570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 10/15/2021] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Diabetes-related foot disease is a large cause of the global disease burden yet receives very little research funding to address this large burden. To help address this gap, it is recommended to first identify the consensus priority research questions of relevant stakeholders, yet this has not been performed for diabetes-related foot disease. The aim of this study was to determine the national top 10 priority research questions for diabetes-related foot health and disease from relevant Australian stakeholders. RESEARCH DESIGN AND METHODS A modified three-round Delphi online survey design was used to seek opinions from relevant Australian stakeholders including those with diabetes or diabetes-related foot disease or their carers (consumers), health professionals, researchers and industry. Participants were recruited via multiple public invitations and invited to propose three research questions of most importance to them (Round 1), prioritize their 10 most important questions from all proposed questions (Round 2), and then rank questions in order of importance (Round 3). RESULTS After Round 1, a total of 226 unique questions were proposed by 210 participants (including 121 health professionals and 72 consumers). Of those participants, 95 completed Round 2 and 69 completed Round 3. The top 10 priority research questions covered a range of topics, including health economics, peripheral neuropathy, education, infection, technology, exercise, and nutrition. Consumers prioritized peripheral neuropathy and prevention-related questions. Health professionals prioritized management-related questions including Australia's First Peoples foot health, health economics and infection questions. CONCLUSIONS These priority research questions should guide future national research agendas, funding and projects to improve diabetes-related foot disease burdens in Australia and globally. Future research should focus on consumer priority research questions to improve the burden of diabetes-related foot disease on patients and nations. Further research should also investigate reasons for different priorities between consumers and health professionals.
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Affiliation(s)
- Byron M Perrin
- La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
- Diabetes Feet Australia, Sydney, New South Wales, Australia
| | - Anita Raspovic
- Discipline of Podiatry, La Trobe University, Melbourne, Victoria, Australia
| | - Cylie M Williams
- School of Primary and Allied Health Care, Monash University, Frankston, Victoria, Australia
| | - Stephen M Twigg
- Diabetes Feet Australia, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- Department of Endocrinology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Jonathan Golledge
- Diabetes Feet Australia, Sydney, New South Wales, Australia
- Queensland Research Centre for Peripheral Vascular Disease, James Cook University, Townsville, Queensland, Australia
- Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, Queensland, Australia
| | - Emma J Hamilton
- Department of Endocrinology, Fiona Stanley Hospital, Perth, Western Australia, Australia
- Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Anna Crawford
- Diabetes Centre, High Risk Foot Service, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | | | | | | | - Peter A Lazzarini
- Diabetes Feet Australia, Sydney, New South Wales, Australia
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
- Allied Health Research Collaborative, The Prince Charles Hospital, Brisbane, Queensland, Australia
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Tume LN, Menzies JC, Ray S, Scholefield BR. Research Priorities for U.K. Pediatric Critical Care in 2019: Healthcare Professionals' and Parents' Perspectives. Pediatr Crit Care Med 2021; 22:e294-e301. [PMID: 33394942 DOI: 10.1097/pcc.0000000000002647] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The Paediatric Intensive Care Society Study Group conducted a research prioritization exercise with the aim to identify and agree research priorities in Pediatric Critical Care in the United Kingdom both from a healthcare professional and parent/caregiver perspective. DESIGN A modified three-round e-Delphi survey, followed by a survey of parents of the top 20 healthcare professional priorities. SETTING U.K. PICUs. PATIENTS U.K. PICU healthcare professionals who are members of the professional society and parents and family members of children, with experience of a U.K. PICU admission. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Forty-nine healthcare professional submitted topics in round 1, 98 participated in round 2, and 102 in round 3. These topics were categorized into eight broad domain areas, and within these, there were 73 specific topics in round 2. At round 3, 18 topics had a mean score less than 5.5 and were removed, leaving 55 topics for ranking in round 3. Ninety-five parents and family members completed the surveys from at least 17 U.K. PICUs. Both parents and healthcare professional prioritized research topics associated with the PICU workforce. Healthcare professional research priorities reflected issues that impacted on day-to-day management and practice. Parents' prioritized research addressing acute situations such as infection identification of and sepsis management or research addressing long-term outcomes for children and parents after critical illness. Parents prioritized research into longer term outcomes more than healthcare professional. Parental responses showed clear support for the concept of research in PICU, but few novel research questions were proposed. CONCLUSIONS This is the first research prioritization exercise within U.K. PICU setting to include parents' and families' perspectives and compare these with healthcare professional. Results will guide both funders and future researchers.
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Affiliation(s)
- Lyvonne N Tume
- School of Health & Society, University of Salford, Salford, United Kingdom
| | - Julie C Menzies
- Paediatric Intensive Care Unit, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom
| | - Samiran Ray
- Paediatric and Neonatal Intensive Care Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Barnaby R Scholefield
- Paediatric Intensive Care Unit, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
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de Barbieri I, Strini V, Noble H, Amatori S, Sisti D. Nurse-perceived facilitators and barriers to palliative care in patients with kidney disease: A European Delphi survey. J Ren Care 2021; 48:49-59. [PMID: 33763991 PMCID: PMC9135123 DOI: 10.1111/jorc.12371] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 02/22/2021] [Accepted: 03/08/2021] [Indexed: 12/05/2022]
Abstract
Background The palliative care phenomenon is increasingly invested in all medicine and nursing fields, as care for people with kidney disease who do not wish to embark on dialysis: it encompasses a palliative approach to shared decision‐making. To deliver patient‐centred optimal care, nephrology healthcare staff should be knowledgeable about palliative care and the appropriate conservative management approach. Objective This paper aimed to explore, using a Delphi survey, the barriers and facilitators to palliative care in patients with kidney disease. Design An e‐Delphi technique with three questionnaire rounds was performed; statements were generated using Likert scales. Participants and Measurements A list of 80 statements related to palliative care in patients with kidney disease was divided into facilitators and barriers. Questionnaires were administered to 13 nephrology nurse experts in some European countries. Results Seven items were removed from the list of 80 statements after the first round of the Delphi study; eight items achieved a significant change of the mean between round two and three, whereas internal stability emerged in all the remaining items. Conclusions Specific training and education in palliative care emerged as a facilitator, as well as the role of spiritual and beliefs and the role of family and caregiver. The main barriers were represented by the differences in cultures, beliefs, and practices and by the lack of experience in the role of the staff in palliative care. These statements provide a platform for future research to improve palliative care practice in patients with kidney disease.
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Affiliation(s)
- Ilaria de Barbieri
- Department of Health Professions, University Hospital of Padova, Padova, Italy
| | - Veronica Strini
- Projects and Clinical Research Unit, University Hospital of Padova, Padova, Italy
| | - Helen Noble
- School of Nursing and Midwifery, Queens's University Belfast, Belfast, UK
| | - Stefano Amatori
- Department of Biomolecular Sciences, Service of Biostatistics, University of Urbino Carlo Bo, Urbino, Italy
| | - Davide Sisti
- Department of Biomolecular Sciences, Service of Biostatistics, University of Urbino Carlo Bo, Urbino, Italy
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Damsma Bakker A, van Leeuwen R, Roodbol P. Ethical considerations regarding the inclusion of children in nursing research. Nurs Ethics 2020; 28:106-117. [PMID: 32996358 DOI: 10.1177/0969733020948120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Evidence-based nursing practice is based on three pillars: the available research, known preferences of the patient or patient group and the professional experience of the nurse. For all pillars, research is the tool to expand the evidence we have, but when implementing evidence-based practice in paediatric nursing two of the pillars demand that children are included as respondents: practice research on the nursing interventions in paediatrics and the preferences of patients, something recognized by scholars and practitioners. But including a vulnerable group as children in nursing research raises specific ethical issues that need to be considered by researchers. What are ethical considerations that are currently raised about doing research with children and what do we learn by synthesizing the narrative of these studies of why the issues are raised and which solutions can be offered for these issues? In this article, considerations on three ethical principles according to the Belmont report are described by examining recent research. Twenty-one studies were found addressing relevant ethical aspects including vulnerability, gaining consent, designing quantitative or qualitative research methods and considerations regarding the execution of the study. Ethical considerations should be much more a case of continuous awareness and attitude, then box-ticking exercise, although there are sufficient international guidelines available specifically for research that includes children to aid researchers.
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Affiliation(s)
| | - René van Leeuwen
- 174395Viaa Christian University of Applied Sciences, The Netherlands
| | - Petrie Roodbol
- 10173University Medical Center Groningen, The Netherlands
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Mörelius E, Foster M, Gill FJ. A Scoping Review of Nursing Research Priorities in Pediatric Care. J Pediatr Nurs 2020; 52:e57-e69. [PMID: 32008833 DOI: 10.1016/j.pedn.2020.01.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 01/17/2020] [Accepted: 01/17/2020] [Indexed: 02/07/2023]
Abstract
PROBLEM Priority setting for pediatric nursing is important to plan, coordinate and direct future research. The aim of this scoping review was to systematically identify and synthesise the nature, range and extent of published pediatric nursing research priorities. ELIGIBILITY CRITERIA English language full text publications focusing generic nursing research priorities for the child or adolescent, indexed in CINAHL, EMBASE, The Cochrane Database of Systematic Reviews, AMED, MEDLINE and PsycINFO and published from 2008 to 2019. SAMPLE A total of 789 citations were identified, 44 full text articles were retrieved and assessed for eligibility and eight studies were finally reviewed, quality assessed (CREDES) and synthesised. RESULTS All eight studies used a consensus building method to identify research priorities reported by nurses. Six used Delphi technique, one Nominal Group Technique (NGT) and one consensus workshop. CREDES score range was 10-14 of a possible 16. Synthesis of the 234 nursing research priorities generated four themes; evidenced-based practice, pediatric context, child and family-centered care; pediatric nursing, with 14 subthemes. CONCLUSION The nursing research priorities reported appear to be still current and important to nurses. There was a focus on acute care, with fewer priorities reflecting areas of child-, school-, or mental- health. Consumer and community priorities have not been reported. IMPLICATIONS These nursing research priorities can be used to inform the national or local research agenda, although there is a need to establish priorities from the perspective of all stakeholders and in particular, identify what is important to consumers.
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Affiliation(s)
- Evalotte Mörelius
- Perth Children's Hospital, Nedlands, WA, Australia; School of Nursing and Midwifery, Edith Cowan University, WA, Australia.
| | - Mandie Foster
- School of Nursing and Midwifery, Edith Cowan University, WA, Australia
| | - Fenella J Gill
- Perth Children's Hospital, Nedlands, WA, Australia; School of Nursing, Midwifery and Paramedicine, Curtin University, WA, Australia
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Science in paediatric and neonatal intensive care nursing: International forces providing evidence to change clinical practice. Aust Crit Care 2020; 32:1-3. [PMID: 30606446 DOI: 10.1016/s1036-7314(18)30385-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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Ullman AJ, Xu H, Mitchell A, Doyle R, Kleidon T, Rickard C, Cooke M, Harley A, Kain V, Forster E, Petsky H. Paediatric nursing research in Australia: A descriptive survey. Collegian 2020. [DOI: 10.1016/j.colegn.2019.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Egerod I, Kaldan G, Lindahl B, Hansen BS, Jensen JF, Collet MO, Halvorsen K, Eriksson T, Olausson S, Jensen HI. Trends and recommendations for critical care nursing research in the Nordic countries: Triangulation of review and survey data. Intensive Crit Care Nurs 2019; 56:102765. [PMID: 31685257 DOI: 10.1016/j.iccn.2019.102765] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 08/04/2019] [Accepted: 08/31/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Priorities for critical care nursing research have evolved with societal trends and values. In the 1980s priorities were the nursing workforce, in 1990s technical nursing, in 2000s evidence-based nursing and in 2010s symptom management and family-centred care. OBJECTIVES To identify current trends and future recommendations for critical care nursing research in the Nordic countries. METHODS We triangulated the results of a literature review and a survey. A review of two selected critical care nursing journals (2016-2017) was conducted using content analysis to identify contemporary published research. A self-administered computerised cross-sectional survey of Nordic critical care nursing researchers (2017) reported current and future areas of research. RESULTS A review of 156 papers identified research related to the patient (13%), family (12%), nurse (31%), and therapies (44%). Current trends in the survey (n = 76, response rate 65%) included patient and family involvement, nurse performance and education, and evidence-based protocols. The datasets showed similar trends, but aftercare was only present in the survey. Future trends included symptom management, transitions, rehabilitation, and new nursing roles. CONCLUSION Critical care nursing research is trending toward increased collaboration with patient and family, delineating a shift toward user values. Recommendations include long-term outcomes and impact of nursing.
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Affiliation(s)
- Ingrid Egerod
- University of Copenhagen, Rigshospitalet, Intensive Care Unit 4131, Blegdamsvej 9, 2100 Copenhagen O, Denmark.
| | - Gudrun Kaldan
- Copenhagen University Hospital, Rigshospitalet, 7831, Blegdamsvej 9, 2100 Copenhagen O, Denmark.
| | - Berit Lindahl
- Faculty of Caring Sciences, Work Life & Social Welfare, University of Borås, Borås, Sweden.
| | - Britt Sætre Hansen
- Department of Anaesthesiology and Intensive Care, Stavanger University Hospital, P.O. Box 8100, N-4068 Stavanger, Norway; Faculty of Health Sciences, Quality and Safety in Health Care Systems, University of Stavanger, N-4036 Stavanger, Norway.
| | - Janet Froulund Jensen
- Department of Anesthesiology, Holbæk Hospital, Smedelundsgade 60, 4300 Holbæk, Denmark.
| | - Marie Oxenbøll Collet
- Department of Intensive Care 4131, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen O, Denmark.
| | - Kristin Halvorsen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Norway.
| | - Thomas Eriksson
- Faculty of Caring Sciences, Work Life & Social Welfare, University of Borås, SE-501 90 Borås, Sweden.
| | - Sepideh Olausson
- Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
| | - Hanne Irene Jensen
- Department of Anaesthesiology and Intensive Care, Vejle and Middelfart Hospitals, Beriderbakken 4, 7100 Vejle, Denmark; Institute of Regional Health Research, University of Southern Denmark, J.B. Winsløwsvej 19, 5000 Odense, Denmark.
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Abstract
Women who experience an uncomplicated vaginal delivery have acute intrapartum pain and variable pain in the immediate postpartum period. Although the Centers for Disease Control and Prevention (CDC) has urged clinicians to improve opioid-prescribing behavior, there are no published clinical practice guidelines for prescribing opioids during labor and delivery and at discharge for patients with uncomplicated normal spontaneous vaginal delivery. To address the knowledge gap regarding guidelines for pain management in this population, we used the national Premiere Health Care Database for deliveries of uncomplicated vaginal births from January 1, 2014, to December 31, 2016, to determine the prevalence of opioid administration. Among the 49,133 women who met inclusion criteria, 78.2% were administered opioids during hospitalization and 29.8% were administered opioids on the day of discharge. Descriptive statistics were generated to document the characteristics of the patients receiving opioids as well as the characteristics of hospitals administering opioids during inpatient labor and delivery and on discharge. Patient-level variables included age group, marital status, race, ethnicity, payer type, and length of stay. Hospital-level variables included bed size, geographic region, teaching status, and urbanicity status. These data were then presented in an electronic Delphi survey to 14 participants. The survey participants were obstetrician-gynecologists identified by the American College of Obstetricians and Gynecologists as being thought leaders in the obstetrics field and who had also demonstrated an active interest in the opioid epidemic and its effect on women's health. After the panelists viewed the opioid administration data, they were presented with an adapted version of the CDC's guidelines for opioid prescribing for chronic pain management. The eight adapted guidelines were constructed to be more relevant and appropriate for the inpatient normal spontaneous vaginal delivery population. After three rounds of the surveying process, seven of the eight adapted guidelines were endorsed by the survey participants. These seven draft consensus guidelines could now be used as a starting point to develop more broadly endorsed and studied guidelines for appropriately managing pain control for women with uncomplicated spontaneous vaginal birth.
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Al Mutair A, Al Ammary M, Brooks LA, Bloomer MJ. Supporting Muslim families before and after a death in neonatal and paediatric intensive care units. Nurs Crit Care 2019; 24:192-200. [PMID: 31124208 DOI: 10.1111/nicc.12434] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 04/11/2019] [Accepted: 04/24/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND The death of a child is regarded as one of the most devastating events for a family. Families are reliant on nurses to not only provide end-of-life care but also to support and care for grieving families in a way that is sensitive to their cultural and religious needs and preferences. AIMS The aim of this study was to explore the perceived impact and influence of cultural diversity on how neonatal and paediatric intensive care nurses care for Muslim families before and after the death of infants/children. DESIGN A qualitative descriptive approach was used in this study, conducted in Saudi Arabia. METHODS Semi-structured interviews were used to gather data from a convenience sample of registered nurses working in neonatal and paediatric intensive care, with experience in providing end-of-life care. Interviews were conducted between July and November, 2018. Interviews were audio-recorded and transcribed for analysis. RESULTS Thirteen registered nurses participated; all were born overseas, identified with various faiths and spoke English in the workplace. A respect for diversity and care of the family was prioritized yet impacted by communication challenges. Caring and respect was demonstrated by facilitating important cultural and religious practices important in the Muslim faith. Self-care was identified as important, transcending the culturally diverse nature of the nursing workforce. CONCLUSIONS Significant challenges exist for a culturally diverse nursing workforce in providing care to a Saudi Muslim population of infants/children and families, before and after a death. Their overriding commitment to respect for others, and an openness to cultural diversity and difference, aided in overcoming the inherent challenges in providing culturally sensitive end-of-life care that meets the needs of Muslim families. These findings provide valuable insights for intensive care clinicians in other countries to address challenges associated with cultural diversity.
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Affiliation(s)
- Abbas Al Mutair
- Research Center, Dr Sulaiman Al Habib Medical Group, Riyadh, Saudi Arabia.,School of Nursing, Wollongong University, Wollongong, New South Wales, Australia.,Alfaisal University, Riyadh, Saudi Arabia
| | - Maram Al Ammary
- Prince Sultan Medical City, Cardiac Center, Riyadh, Saudi Arabia
| | - Laura A Brooks
- School of Nursing and Midwifery, Deakin University, Geelong, Melbourne, Australia
| | - Melissa J Bloomer
- School of Nursing and Midwifery, Deakin University, Geelong, Melbourne, Australia.,Centre for Quality and Patient Safety Research, Deakin University, Geelong, Melbourne, Australia
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Booth A, Maddison J, Wright K, Fraser L, Beresford B. Research prioritisation exercises related to the care of children and young people with life-limiting conditions, their parents and all those who care for them: A systematic scoping review. Palliat Med 2018; 32:1552-1566. [PMID: 30404588 PMCID: PMC6238162 DOI: 10.1177/0269216318800172] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND In planning high-quality research in any aspect of care for children and young people with life-limiting conditions, it is important to prioritise resources in the most appropriate areas. AIM To map research priorities identified from existing research prioritisation exercises relevant to infants, children and young people with life-limiting conditions, in order to inform future research. DESIGN We undertook a systematic scoping review to identify existing research prioritisation exercises; the protocol is publicly available on the project website. DATA SOURCES The bibliographic databases ASSIA, CINAHL, MEDLINE/MEDLINE In Process and Embase were searched from 2000. Relevant reference lists and websites were hand searched. Included were any consultations aimed at identifying research for the benefit of neonates, infants, children and/or young people (birth to age 25 years) with life-limiting, life-threatening or life-shortening conditions; their family, parents, carers; and/or the professional staff caring for them. RESULTS A total of 24 research prioritisation exercises met the inclusion criteria, from which 279 research questions or priority areas for health research were identified. The priorities were iteratively mapped onto an evolving framework, informed by World Health Organization classifications. This resulted in identification of 16 topic areas, 55 sub-topics and 12 sub-sub-topics. CONCLUSION There are numerous similar and overlapping research prioritisation exercises related to children and young people with life-limiting conditions. By mapping existing research priorities in the context in which they were set, we highlight areas to focus research efforts on. Further priority setting is not required at this time unless devoted to ascertaining families' perspectives.
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Affiliation(s)
- Alison Booth
- Martin House Research Centre, Department of Health Sciences, Faculty of Sciences, University of York, York, UK
| | - Jane Maddison
- Social Policy Research Unit, University of York, York, UK
| | - Kath Wright
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Lorna Fraser
- Martin House Research Centre, Department of Health Sciences, Faculty of Sciences, University of York, York, UK
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Kelly CA, Kirkcaldy AJ, Pilkington M, Hodson M, Welch L, Yorke J, Knighting K. Research priorities for respiratory nursing: a UK-wide Delphi study. ERJ Open Res 2018; 4:00003-2018. [PMID: 29692999 PMCID: PMC5909062 DOI: 10.1183/23120541.00003-2018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 03/09/2018] [Indexed: 11/30/2022] Open
Abstract
Respiratory nurses make a significant contribution to the delivery of respiratory healthcare, but there is a dearth of nurse-led, practice-focused, published research. Using a modified three-round Delphi, this study sought to identify research priorities for respiratory nursing to inform a national research strategy. Study information and the survey link were sent electronically to members of UK professional respiratory organisations. Round 1 had 78 items across 16 topics, informed by a systematic literature review. Respondents suggested additional items which were content analysed to inform Round 2. Respondents rated all items and ranked the topics in all rounds. To ensure rigour, rounds had an explicit focus with pre-determined criteria for consensus (70%). In total, 363 responses were received across Rounds 1, 2 and 3 (n=183, 95 and 85, respectively). The top five research priorities were: 1) “Patient understanding of asthma control”; 2) “The clinical and cost-effectiveness of respiratory nurse interventions”; 3) “The impact of nurse-led clinics on patient care”; 4) “Inhaler technique”; and 5) two topics jointly scored: “Prevention of exacerbations” and “Symptom management”. With potential international significance, this is the first UK study to identify research priorities for respiratory nursing, providing direction for those planning or undertaking research. UK-wide Delphi survey identifies nursing research priorities to enhance respiratory care for patients and carershttp://ow.ly/ekGt30iXYXt
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Affiliation(s)
- Carol Ann Kelly
- Postgraduate Medical Institute, Edge Hill University, Ormskirk, UK
| | - Andrew J Kirkcaldy
- Evidence-based Practice Research Centre, Edge Hill University, Ormskirk, UK
| | - Melissa Pilkington
- Evidence-based Practice Research Centre, Edge Hill University, Ormskirk, UK
| | - Matthew Hodson
- Homerton University Hospital Foundation Trust and Association of Respiratory Nurse Specialists, London, UK
| | - Lindsay Welch
- Solent NHS Trust and the University of Southampton, and Association of Respiratory Nurse Specialists, Southampton, UK
| | - Janelle Yorke
- Division of Nursing, Midwifery and Social Work, Faculty of Biology, Medicine, Health Sciences, University of Manchester, Manchester, UK
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Latour JM, Coombs M. Family-centred care in Intensive Care: Moving the evidence forward-A call for papers. Intensive Crit Care Nurs 2017; 42:1-2. [PMID: 28789865 DOI: 10.1016/j.iccn.2017.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Jos M Latour
- School of Nursing and Midwifery, Faculty of Health and Human Sciences, University of Plymouth, 3 Portland Villas, Room 101, Drake Circus, Plymouth PL4 8AA, United Kingdom.
| | - Maureen Coombs
- Graduate School of Nursing, Midwifery and Health, Victoria University of Wellington, Level 7 Clinical Services Block, Wellington Regional Hospital, Riddiford Street, Newtown, Wellington 6021, New Zealand.
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Abstract
OBJECTIVES This survey had three key objectives: 1) To describe responsibility for key ventilation and weaning decisions in European PICUs and explore variations across Europe; 2) To describe the use of protocols, spontaneous breathing trials, noninvasive ventilation, high-flow nasal cannula use, and automated weaning systems; and 3) To describe nurse-to-patient staffing ratios and perceived nursing autonomy and influence over ventilation decision making. DESIGN Cross-sectional electronic survey. SETTING European PICUs. PARTICIPANTS Senior ICU nurse and physician from participating PICUs. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Response rate was 64% (65/102) representing 19 European countries. Determination of weaning failure was most commonly based on collaborative decision making (81% PICUs; 95% CI, 70-89%). Compared to this decision, selection of initial ventilator settings and weaning method was least likely to be collaborative (relative risk, 0.30; 95% CI, 0.20-0.47 and relative risk, 0.45; 95% CI, 0.32-0.45). Most PICUs (> 75%) enabled physicians in registrar (fellow) positions to have responsibility for key ventilation decisions. Availability of written guidelines/protocols for ventilation (31%), weaning (22%), and noninvasive ventilation (33%) was uncommon, whereas sedation protocols (66%) and sedation assessment tools (76%) were common. Availability of protocols was similar across European regions (all p > 0.05). High-flow nasal cannula (53%), noninvasive ventilation (52%) to avoid intubation, and spontaneous breathing trials (44%) were used in approximately half the PICUs greater than 50% of the time. A nurse-to-patient ratio of 1:2 was most frequent for invasively (50%) and noninvasively (70%) ventilated patients. Perceived nursing autonomy (median [interquartile range], 4 [2-6]) and influence (median [interquartile range], 7 [5-8]) for ventilation and weaning decisions varied across Europe (p = 0.007 and p = 0.01, respectively) and were highest in Northern European countries. CONCLUSIONS We found variability across European PICUs in interprofessional team involvement for ventilation decision making, nurse staffing, and perceived nursing autonomy and influence over decisions. Patterns of adoption of tools/adjuncts for weaning and sedation were similar.
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Tume LN, Ista E, van den Hoogen A, Wielenga J, Latour JM. A roadmap for paediatric and neonatal critical care nursing science in Europe: engage, action and impact. Nurs Crit Care 2017; 20:224-6. [PMID: 26268197 DOI: 10.1111/nicc.12175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Lyvonne N Tume
- PICU and Children's Nursing Research Unit, Alder Hey Children's NHS, Liverpool L12 2AP, UK. .,University of Central Lancashire, School of Health, Preston PR1 2HE, UK.
| | - Erwin Ista
- Department of Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
| | - Agnes van den Hoogen
- Clinical Health Science Research & Education Division Woman and Baby University Medical Center Utrecht Utrecht, The Netherlans.
| | - Joke Wielenga
- Intensive Care Neonatology Emma Children's Hospital Academic Medical Centre Amsterdam, The Netherlands.
| | - Jos M Latour
- School of Nursing and Midwifery, Faculty of Health and Human Sciences, Plymouth University, Plymouth, Devon PL4 8AA, UK. , .,School of Nursing and Midwifery, Faculty of Health Science, Curtin University, Perth 6102, Australia. ,
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20
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Henderson RJ, Johnson AM, Moodie ST. Revised Conceptual Framework of Parent-to-Parent Support for Parents of Children Who Are Deaf or Hard of Hearing: A Modified Delphi Study. Am J Audiol 2016; 25:110-26. [PMID: 27249168 DOI: 10.1044/2016_aja-15-0059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 12/28/2015] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND A scoping review of the literature was conducted, resulting in the development of a conceptual framework of parent-to-parent support for parents with children who are Deaf or hard of hearing. This is the 2nd stage of a dual-stage scoping review. PURPOSE This study sought stakeholder opinion and feedback with an aim to achieve consensus on the constructs, components, and design of the initial conceptual framework. RESEARCH DESIGN A modified electronic Delphi study was completed with 21 handpicked experts from 7 countries who have experience in provision, research, or experience in the area of parent-to-parent support. Participants completed an online questionnaire using an 11-point Likert scale (strongly disagree to strongly agree) and open-ended questions to answer various questions related to the descriptor terms, definitions, constructs, components, and overall design of the framework. RESULTS Participant responses led to the revision of the original conceptual framework. CONCLUSION The findings from this dual-stage scoping review and electronic Delphi study provide a conceptual framework that defines the vital contribution of parents in Early Hearing Detection and Intervention programs that will be a useful addition to these programs.
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Affiliation(s)
- Rebecca J. Henderson
- Health & Rehabilitation Sciences Program, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
| | - Andrew M. Johnson
- Health & Rehabilitation Sciences Program, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
| | - Sheila T. Moodie
- Health & Rehabilitation Sciences Program, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
- National Centre for Audiology, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
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Monterosso L, Ross-Adjie G, Keeney S. Developing a research agenda for nursing and midwifery: a modified Delphi study. Contemp Nurse 2016; 51:83-95. [PMID: 26565131 DOI: 10.1080/10376178.2015.1116372] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AIM We sought to ascertain the nursing and midwifery research priorities at a large private tertiary hospital in Australia. DESIGN A modified Delphi technique with two rounds of questionnaires. METHODS The first round survey was distributed to 448 nurses and midwives with a 19.2% (n=86) response rate. Due to a low response rate in some specialties, the second round of the Delphi was only sent to nurses in the Learning and Organisational Development speciality who were asked to rank 10 identified topics specific to Learning and Organisational Development using a five point Likert-type scale. RESULTS Two hundred and fifty seven topics were identified in Round One and were condensed to 181 topics. Each topic was assigned to one of four categories: clinical audit; existing evidence base; research; or other topics which fell beyond the bounds of nursing or midwifery research. Twenty three research topics were identified with priorities focusing on learning and development and workforce issues. CONCLUSION Priorities were congruent with the organisation's strategic workforce focus. Topics identified in this study will ensure that the nursing and midwifery research conducted at the study setting is relevant and reflects priorities as determined by clinical nurses and midwives.
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Affiliation(s)
- Leanne Monterosso
- a St John of God Murdoch Hospital, Centre for Nursing and Midwifery , 100 Murdoch Drive, Murdoch , WA 6150 , Australia.,b School of Nursing and Midwifery , University of Notre Dame Australia , Fremantle , WA , Australia.,c School of Nursing and Midwifery , Edith Cowan University , Mount Lawley , WA , Australia
| | - Gail Ross-Adjie
- a St John of God Murdoch Hospital, Centre for Nursing and Midwifery , 100 Murdoch Drive, Murdoch , WA 6150 , Australia.,b School of Nursing and Midwifery , University of Notre Dame Australia , Fremantle , WA , Australia
| | - Sinead Keeney
- d School of Nursing , University of Ulster , Jordanstown Campus, Shore Road, Newtownabbey Co. Antrim, Londonderry , UK
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Abstract
OBJECTIVE To identify and prioritize research questions of concern to the practice of pediatric critical care nursing practice. DESIGN One-day consensus conference. By using a conceptual framework by Benner et al describing domains of practice in critical care nursing, nine international nurse researchers presented state-of-the-art lectures. Each identified knowledge gaps in their assigned practice domain and then poised three research questions to fill that gap. Then, meeting participants prioritized the proposed research questions using an interactive multivoting process. SETTING Seventh World Congress on Pediatric Intensive and Critical Care in Istanbul, Turkey. PARTICIPANTS Pediatric critical care nurses and nurse scientists attending the open consensus meeting. INTERVENTIONS Systematic review, gap analysis, and interactive multivoting. MEASUREMENTS AND MAIN RESULTS The participants prioritized 27 nursing research questions in nine content domains. The top four research questions were 1) identifying nursing interventions that directly impact the child and family's experience during the withdrawal of life support, 2) evaluating the long-term psychosocial impact of a child's critical illness on family outcomes, 3) articulating core nursing competencies that prevent unstable situations from deteriorating into crises, and 4) describing the level of nursing education and experience in pediatric critical care that has a protective effect on the mortality and morbidity of critically ill children. CONCLUSIONS The consensus meeting was effective in organizing pediatric critical care nursing knowledge, identifying knowledge gaps and in prioritizing nursing research initiatives that could be used to advance nursing science across world regions.
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Wielenga JM, Tume LN, Latour JM, van den Hoogen A. European neonatal intensive care nursing research priorities: an e-Delphi study. Arch Dis Child Fetal Neonatal Ed 2015; 100:F66-71. [PMID: 25260359 DOI: 10.1136/archdischild-2014-306858] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE This study aimed to identify and prioritise neonatal intensive care nursing research topics across Europe using an e-Delphi technique. DESIGN An e-Delphi technique with three questionnaire rounds was performed. Qualitative responses of round one were analysed by content analysis and research statements were generated to be ranged on importance on a scale of 1-6 (not important to most important). SETTING Neonatal intensive care units (NICUs) in 17 European countries. POPULATION NICU clinical nurses, managers, educators and researchers (n=75). INTERVENTION None. MAIN OUTCOME MEASURES A list of 43 research statements in eight domains. RESULTS The six highest ranking statements (≥5.0 mean score) were related to prevention and reduction of pain (mean 5.49; SD 1.07), medication errors (mean 5.20; SD 1.13), end-of-life care (mean 5.05; SD 1.18), needs of parents and family (mean 5.04; SD 1.23), implementing evidence into nursing practice (mean 5.02; SD 1.03), and pain assessment (mean 5.02; SD 1.11). The research domains were prioritised and ranked: (1) pain and stress; (2) family centred care; (3) clinical nursing care practices; (4) quality and safety; (5) ethics; (6) respiratory and ventilation; (7) infection and inflammation; and (8) professional issues in neonatal intensive care nursing. CONCLUSIONS The results of this study might support developing a nursing research strategy for the nursing section of the European Society of Paediatric and Neonatal Intensive Care. In addition, this may promote more European researcher collaboratives for neonatal nursing research.
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Affiliation(s)
- Joke M Wielenga
- Department of Intensive Care Neonatology, Emma Children's Hospital/Academic Medical Centre, Amsterdam, The Netherlands
| | - Lyvonne N Tume
- PICU and Children's Nursing Research Unit, Alder Hey Children's NHS FT, Liverpool UK and University of Central Lancashire, Preston, UK
| | - Jos M Latour
- Faculty of Health and Human Sciences, School of Nursing and Midwifery, Plymouth University, Plymouth, UK Faculty of Health Sciences, School of Nursing and Midwifery, Curtin University, Perth, Western Australia, Australia Department of Paediatrics, Intensive Care Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Agnes van den Hoogen
- Department of Intensive Care Neonatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
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Toward a more perfect (European) union*. Pediatr Crit Care Med 2014; 15:500-2. [PMID: 24892487 DOI: 10.1097/pcc.0000000000000110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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