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Mimmo L, Hodgins M, Samir N, Travaglia J, Woolfenden S, Harrison R. 'Smiles and laughter and all those really great things': Nurses' perceptions of good experiences of care for inpatient children and young people with intellectual disability. J Adv Nurs 2022; 78:2933-2948. [PMID: 35451515 PMCID: PMC9544709 DOI: 10.1111/jan.15256] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 02/11/2022] [Accepted: 03/23/2022] [Indexed: 11/28/2022]
Abstract
AIM To understand what constitutes a good experience of care for inpatient children and young people with intellectual disability as perceived by nursing staff. DESIGN Interpretive qualitative study. METHODS Focus groups with clinical nursing staff from speciality neurological/neurosurgical and adolescent medicine wards across two specialist tertiary children's hospitals in Australia were conducted between March and May 2021. Data analysis followed interpretative analysis methods to develop themes and codes which were mapped to a conceptual model of safe care. RESULTS Six focus groups with 29 nurses of varying experience levels were conducted over 3 months. Themes and codes were mapped to the six themes of the conceptual model: use rapport, know the child, negotiate roles, shared learning, build trust and relationships, and past experiences. The analysis revealed two new themes that extended the conceptual model to include; the unique role of a paediatric nurse, and joy and job satisfaction, with a third contextual theme, impacts of COVID-19 pandemic restrictions. With the perspectives of paediatric nurses incorporated into the model we have enhanced our model of safe care specifically for inpatient paediatric nursing care of children and young people with intellectual disability. CONCLUSION Including perceptions of paediatric nurses confirmed the position of the child with intellectual disability being at the centre of safe care, where care is delivered as a partnership between nursing staff, child or young person and their parents/family and the hospital systems and processes. IMPACT The enhanced model offers a specialized framework for clinical staff and health managers to optimize the delivery of safe care for children and young people with intellectual disability in hospital.
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Affiliation(s)
- Laurel Mimmo
- Clinical Governance UnitThe Sydney Children's Hospitals NetworkSydneyNSWAustralia
- Population Child Health Research GroupSchool of Women's and Children's HealthFaculty of MedicineUniversity of New South WalesSydneyNSWAustralia
| | - Michael Hodgins
- Population Child Health Research GroupSchool of Women's and Children's HealthFaculty of MedicineUniversity of New South WalesSydneyNSWAustralia
| | - Nora Samir
- Population Child Health Research GroupSchool of Women's and Children's HealthFaculty of MedicineUniversity of New South WalesSydneyNSWAustralia
| | - Joanne Travaglia
- Centre for Health Services ManagementFaculty of HealthUniversity of Technology SydneySydneyNSWAustralia
| | - Susan Woolfenden
- Population Child Health Research GroupSchool of Women's and Children's HealthFaculty of MedicineUniversity of New South WalesSydneyNSWAustralia
| | - Reema Harrison
- Centre for Health Systems and Safety ResearchAustralian Institute of Health InnovationFaculty of Medicine, Health and Human SciencesMacquarie UniversitySydneyNSWAustralia
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2
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Østervang C, Geisler Johansen L, Friis-Brixen A, Myhre Jensen C. Experiences of nursing care for patients who self-harm and suggestions for future practices: The perspectives of emergency care nurses. Int J Ment Health Nurs 2022; 31:70-82. [PMID: 34506045 DOI: 10.1111/inm.12933] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 07/02/2021] [Accepted: 08/30/2021] [Indexed: 11/29/2022]
Abstract
Self-harm is a major challenge in healthcare systems. Emergency department nurses provide care to numerous patients with self-harm injuries. Accordingly, nurse-patient interactions are vital to improve the physical and psychological outcomes of this complex patient group. Previous studies have proposed the establishment of improved teaching programs to increase the competence of emergency department nurses within mental health care; however, few studies have comprehensively investigated the experiences and suggestions for future nursing practices. Therefore, we gathered in-depth knowledge of Danish emergency department nurses' experiences caring for patients who self-harm and obtained their suggestions on future nursing practices. Ten semi-structured interviews were conducted to capture the nurses' individual perspectives. The scientific theory is based on phenomenology and hermeneutics. Interpretative phenomenological analysis was used, and three themes were identified: (i) importance of having the competences to establish a relationship in the acute phase; (ii) acute care from a biomedical perspective; and (iii) highlighting ideas for improved future practices. The emergency department nurses were aware of the importance of mental health care but found their competence and motivation situated in medical care. The nurses felt that they lacked skills to undertake in-depth mental care for patients who self-harm and that the healthcare system failed to help this group of patients. Based on these findings, rather than aiming at improving nursing skills, we suggest a close collaboration between the emergency and psychiatric departments to improve the quality of care for patients who self-harm. We also recommend organizational changes within the emergency department, such as the introduction of a so-called 'social track'.
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Affiliation(s)
- Christina Østervang
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Laerke Geisler Johansen
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark.,University of Southern Denmark, Odense, Denmark
| | | | - Charlotte Myhre Jensen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Orthopedics Surgery and Traumatology, University of Southern Denmark, Odense, Denmark
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3
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Perceptions of Experiences of Recovery After Pancreaticoduodenectomy—A Phenomenographic Interview Study. Cancer Nurs 2022; 45:172-180. [DOI: 10.1097/ncc.0000000000001021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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4
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Hawkins SF, Morse JM. Untenable Expectations: Nurses’ Work in the Context of Medication Administration, Error, and the Organization. Glob Qual Nurs Res 2022; 9:23333936221131779. [PMID: 36387044 PMCID: PMC9663611 DOI: 10.1177/23333936221131779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 09/16/2022] [Accepted: 09/23/2022] [Indexed: 11/16/2022] Open
Abstract
We explored nurses’ work in the context of medication administration, errors, and the organization. Secondary analysis of ethnographic data included 92 hours of non-participant observation, and 37 unstructured interviews with nurses, administrators, and pharmacists. Think-aloud observations and analysis of institutional documents supplemented these data. Findings revealed the nature of nurses’ work was characterized by chasing a standard of care, prioritizing practice, and renegotiating routines. The rich description identified characteristics of nurses’ work as cyclical, chaotic and complex shattering studies that explained nurses’ work as linear. A new theoretical model was developed, illustrating the inseparability of nurses’ work from contextual contingencies and enhancing our understanding of the cascading components of work that result in days that spin out of the nurses’ control. These results deepen our understanding why present efforts targeting the reduction of medication errors may be ineffective and places administration accountable for the context in which medication errors occur.
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5
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Psychological interventions for reducing anxiety in patients undergoing first-time colonoscopy: a pilot and feasibility study. Eur J Gastroenterol Hepatol 2021; 33:e634-e641. [PMID: 34034274 DOI: 10.1097/meg.0000000000002186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES To assess the feasibility of a randomized controlled trial (RCT), evaluating the efficacy and patients' perceptions of a psychological intervention aimed at reducing anxiety levels in adults undergoing first-time colonoscopy. METHODS Adults undergoing first-time colonoscopy were randomized to a psychological intervention vs. sham intervention. The primary outcome was feasibility, defined as a recruitment rate of >50%. Patients' state anxiety was assessed before and after the intervention using the state-trait inventory for cognitive and somatic anxiety (STICSA) score. Follow-up interviews were performed within 1 week with a sample of patients and focus groups with clinical staff. RESULTS A total of 130 patients were recruited from 180 eligible patients (72%). Eighty were randomized and completed the study (n = 39) in the psychological intervention group and (n = 41) in the sham. In the psychological intervention group, pre- and postmedian STICSA scores were 29 and 24 (P < 0.001), respectively. In the sham group, pre- and postmedian scores were 31 and 25 (P < 0.001), respectively. Follow-up interviews with patients (n = 13) suggested that 100% of patients perceived the psychological intervention as beneficial and would recommend it to others. CONCLUSION The study was feasible. Patients in both groups improved their anxiety scores, but there were no significant differences between arms. Despite this, patients receiving psychological intervention perceived a benefit from the relaxation exercises.
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6
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Understanding help-seeking decisions in people with subjective cognitive decline: A systematic review of qualitative studies. Geriatr Nurs 2021; 42:1507-1516. [PMID: 34735997 DOI: 10.1016/j.gerinurse.2021.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To synthesize the findings of qualitative research on help-seeking in people with subjective cognitive decline. METHODS Relevant qualitative studies were identified by searching the PubMed, CINAHL, Ovid Medline, PsycInfo, Embase, and Web of Science databases. Studies that investigated help-seeking behavior in older adults with subjective cognitive decline were retrieved. The systematic review was conducted in line with JBI methodology for systematic reviews of qualitative evidence. RESULTS 11 studies were included and three themes related to the process of help-seeking for cognitive problems emerged. These themes included: detected changes, challenges in identifying the need for help and decision to seek professional help. CONCLUSION Making decisions to seek help for people with subjective cognitive decline is a multi-stage process. A better understanding of the complex psychological responses to subjective cognitive decline among older adults may help health care professionals to develop strategies to improve help-seeking in clinical practice.
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Leeman J, Rohweder C, Lee M, Brenner A, Dwyer A, Ko LK, O'Leary MC, Ryan G, Vu T, Ramanadhan S. Aligning implementation science with improvement practice: a call to action. Implement Sci Commun 2021; 2:99. [PMID: 34496978 PMCID: PMC8424169 DOI: 10.1186/s43058-021-00201-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 08/25/2021] [Indexed: 12/24/2022] Open
Abstract
Background In several recent articles, authors have called for aligning the fields of implementation and improvement science. In this paper, we call for implementation science to also align with improvement practice. Multiple implementation scholars have highlighted the importance of designing implementation strategies to fit the existing culture, infrastructure, and practice of a healthcare system. Worldwide, healthcare systems are adopting improvement models as their primary approach to improving healthcare delivery and outcomes. The prevalence of improvement models raises the question of how implementation scientists might best align their efforts with healthcare systems’ existing improvement infrastructure and practice. Main body We describe three challenges and five benefits to aligning implementation science and improvement practice. Challenges include (1) use of different models, terminology, and methods, (2) a focus on generalizable versus local knowledge, and (3) limited evidence in support of the effectiveness of improvement tools and methods. We contend that implementation science needs to move beyond these challenges and work toward greater alignment with improvement practice. Aligning with improvement practice would benefit implementation science by (1) strengthening research/practice partnerships, (2) fostering local ownership of implementation, (3) generating practice-based evidence, (4) developing context-specific implementation strategies, and (5) building practice-level capacity to implement interventions and improve care. Each of these potential benefits is illustrated in a case study from the Centers for Disease Control and Prevention’s Cancer Prevention and Control Research Network. Conclusion To effectively integrate evidence-based interventions into routine practice, implementation scientists need to align their efforts with the improvement culture and practice that is driving change within healthcare systems worldwide. This paper provides concrete examples of how researchers have aligned implementation science with improvement practice across five implementation projects. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-021-00201-1.
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Affiliation(s)
- Jennifer Leeman
- School of Nursing, The University of North Carolina at Chapel Hill, CB #7460, Chapel Hill, NC, 27599, USA.
| | - Catherine Rohweder
- Center for Health Promotion & Disease Prevention, The University of North Carolina at Chapel Hill, CB #7424, Carrboro, NC, 27510, USA
| | - Matthew Lee
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Ave, 8th Floor, New York, NY, 10016, USA
| | - Alison Brenner
- Department of General Medicine & Clinical Epidemiology, UNC School of Medicine, The University of North Carolina at Chapel Hill, CB #7293, Carrboro, NC, 27510, USA
| | - Andrea Dwyer
- University of Colorado Cancer Center, 13001 East 17th Avenue, Aurora, CO, 80045, USA
| | - Linda K Ko
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, USA.,Department of Cancer Prevention, Fred Hutchinson Cancer Research Center, Hans Rosling Center for Public Health, 3980 15th Avenue NE, 4th Floor, Seattle, WA, 98195, USA
| | - Meghan C O'Leary
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, CB #7400, Chapel Hill, NC, 27599, USA
| | - Grace Ryan
- The University of Iowa, 145 N. Riverside Drive, N475 CPHB, Iowa City, IA, 52242, USA
| | - Thuy Vu
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, USA
| | - Shoba Ramanadhan
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
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8
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Asking "Meaning Questions" in Evidence-Based Reviews and the Utility of Qualitative Findings in Practice. Dimens Crit Care Nurs 2021; 40:288-294. [PMID: 34398565 DOI: 10.1097/dcc.0000000000000488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Evidence-based practice (EBP) systematic reviews are mostly conducted using etiology, diagnosis, therapy, prevention, and prognosis question format. "Meaning" or qualitative questions are very rarely used. The purpose of this article is to discuss qualitative findings' contribution to EBP through asking "meaning questions" in conducting systematic reviews and the utilization of the results to practice. Two EBP systematic review exemplars using meaning questions including the relevance and utilization of qualitative findings in health care decision-making, practice, and policy are presented. There is a need to instill an evidence-based mindset into systematic reviews that balance scientific knowledge gained through empirical research and evidence from qualitative studies. This is turn will increase awareness among clinicians and decision makers on the different ways in which qualitative evidence can be used and applied in practice.
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9
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Berthelsen C, Koreska M. Creating a practice-related culture for research: A qualitative study of engaging clinical nurses in utilization of developmental and research-based knowledge in hospital settings. Int J Nurs Pract 2021; 27:e12990. [PMID: 34227184 DOI: 10.1111/ijn.12990] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 04/29/2021] [Accepted: 06/18/2021] [Indexed: 11/27/2022]
Abstract
AIM To describe academic nurses' experiences engaging clinical nurses in utilizing and implementing developmental and research-based knowledge in hospital settings. METHODS This study used a descriptive qualitative design. Fourteen academic nurses at Masters or PhD level from three different regions of Denmark participated in the study, relating their successful experiences engaging clinical nurses in utilizing and implementing developmental and research-based knowledge. Data were collected in February 2020 through qualitative semi-structured interviews and analysed using a qualitative manifest content analysis. RESULTS The main theme revealed was that academic nurses were 'Working towards creating a practice-related culture for research' to engage clinical nurses. This was supported by three subthemes: 'Focusing on evidence-based practice knowledge', 'Facilitating knowledge through a pedagogical approach' and 'Aiming for future changes'. CONCLUSIONS The academic nurses experienced their engagement of clinical nurses and the subsequent change of practice in patient care and nurses' workflows in the department settings, as successful due to the academic nurses' pedagogical actions to educate clinical nurses and due to the academic nurses' practice-related approach to research and implementation.
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Affiliation(s)
- Connie Berthelsen
- Section of Nursing, Institute of Health Science, Aarhus University, Copenhagen, Denmark
| | - Mai Koreska
- Department of Neurology, Rigshospitalet, Denmark
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10
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Maxwell AM, Reay RE, Huber A, Hawkins E, Woolnough E, McMahon C. Parent and practitioner perspectives on Circle of Security Parenting (COS-P): A qualitative study. Infant Ment Health J 2021; 42:452-468. [PMID: 33852163 DOI: 10.1002/imhj.21916] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Circle of Security Parenting (COS-P) is an attachment-theory-informed program for parents of infants and young children. Designed for scalability, COS-P has been widely adopted internationally. Evidence for the program's effectiveness is limited, however, restricting capacity to make informed decisions about program allocation, and threatening ongoing program funding. To help address this evidence gap, this qualitative study explored the experiences and perceptions of 20 COS-P facilitators and 14 parent recipients in Australia, where COS-P uptake has been particularly widespread. Thematic analysis of combined interview and focus group data revealed a perception that COS-P primarily changes the lens through which parents view (a) their child, (b) themselves in the parenting role, and (c) the parent-child relationship, and that this was a pathway to increased empathy, compassion, and parenting confidence. Participants identified four components that underpinned program impact: key content, skills practice, group processes, and facilitator support. Although COS-P was considered suitable for broad application, limitations were noted. Findings can guide clinical application of COS-P and inform empirical research.
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Affiliation(s)
- Anne-Marie Maxwell
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - Rebecca E Reay
- Academic Unit of Psychiatry and Addiction Medicine, ANU Medical School, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Anna Huber
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - Erinn Hawkins
- Menzies Health Institute Queensland, School of Applied Psychology, Griffith University, Gold Coast, Queensland, Australia
| | - Erin Woolnough
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - Catherine McMahon
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
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11
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Praxisbasierte Evidenz. Public Health 2021. [DOI: 10.1007/978-3-658-30377-8_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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12
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Dovel K, Phiri K, Mphande M, Mindry D, Sanudi E, Bellos M, Hoffman RM. Optimizing Test and Treat in Malawi: health care worker perspectives on barriers and facilitators to ART initiation among HIV-infected clients who feel healthy. Glob Health Action 2020; 13:1728830. [PMID: 32098595 PMCID: PMC7054923 DOI: 10.1080/16549716.2020.1728830] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background: Test and Treat has been widely adopted throughout sub-Saharan Africa, whereby all HIV-positive individuals initiate antiretroviral therapy (ART) immediately upon diagnosis and continue for life. However, clients who feel healthy may delay ART initiation, despite being eligible under new treatment guidelines. Objective: We examined health care worker (HCW) perceptions and experiences on how feeling healthy positively or negatively influences treatment initiation among HIV-positive clients in Malawi. Methods: We conducted 12 focus group discussions with 101 HCWs across six health facilities in Central Malawi. Data were analyzed through constant comparison methods using Atlas.ti7.5. Results: Feeling healthy influences perceptions of ART initiation among HIV-positive clients. HCWs described that healthy clients feel that there are few tangible benefits to immediate ART initiation, but numerous risks. Fear of stigma and unwanted disclosure, disruption of daily activities, fear of side effects, and limited knowledge about the benefits of early initiation were perceived by HCWs to deter healthy clients from initiating ART. Conclusion: Feeling healthy may exacerbate barriers to ART initiation. Strategies to reach healthy clients are needed, such as chronic care models, differentiated models of care that minimize disruptions to daily activities, and community sensitization on the benefits of early initiation.
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Affiliation(s)
- Kathryn Dovel
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA.,Partners in Hope Medical Centre, EQUIP Innovations for Health, Lilongwe, Malawi
| | - Khumbo Phiri
- Partners in Hope Medical Centre, EQUIP Innovations for Health, Lilongwe, Malawi
| | - Misheck Mphande
- Partners in Hope Medical Centre, EQUIP Innovations for Health, Lilongwe, Malawi
| | - Deborah Mindry
- UC Global Health Institute, Center for Women's Health Gender and Empowerment, Los Angeles, CA, USA
| | - Esnart Sanudi
- Partners in Hope Medical Centre, EQUIP Innovations for Health, Lilongwe, Malawi
| | - Mcdaphton Bellos
- Partners in Hope Medical Centre, EQUIP Innovations for Health, Lilongwe, Malawi
| | - Risa M Hoffman
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA
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de la Cuesta-Benjumea C, Arredondo-González CP, Lidón-Cerezuela B, Abad-Corpa E. [Fall prevention in older people and their families: a qualitative synthesis]. GACETA SANITARIA 2020; 35:186-192. [PMID: 33268110 DOI: 10.1016/j.gaceta.2019.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 10/28/2019] [Accepted: 10/29/2019] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To analyse and synthesize the evidence on fall prevention of people older than 65 years and their family care providers METHOD: Qualitative synthesis, which is a part of a convergent systematic integrative review. Forty-one qualitative studies were retained for full text scrutiny. Nine studies on family care providers were selected for this synthesis. RESULTS Care providing, and kinship relationships mediated family care providers' interventions to prevent falls in older people. The fall of the dependent relative constitutes a turning point in these relationships. Family care providers are vulnerable to having a fall themselves and therefore receivers of preventive interventions. CONCLUSIONS Taking into account the context of care and family relations will improve the effectiveness of preventive interventions and will facilitate adherence. Fall prevention policy and programmes must pay better attention to the health and wellbeing of family care providers.
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Affiliation(s)
- Carmen de la Cuesta-Benjumea
- Departamento de Psicología de la Salud, Universidad de Alicante, Alicante, España; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, España
| | | | | | - Eva Abad-Corpa
- Departamento de Enfermería, Universidad de Murcia, Murcia, España; Hospital Reina Sofía, Servicio Murciano de Salud, Murcia, España; IMIB-Arrixaca; Investén-iscii, Murcia, España; CIBERFES, Murcia, España
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Parker P, Aston J, de Rijk L. A systematic review of the evidence base for the Lightning Process. Explore (NY) 2020; 17:372-379. [PMID: 32888829 DOI: 10.1016/j.explore.2020.07.014] [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] [Received: 10/18/2019] [Revised: 07/30/2020] [Accepted: 07/31/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Lightning Process (LP), a mind-body training programme, has been applied to a range of health problems and disorders. Studies and surveys report a range of outcomes creating a lack of clarity about the efficacy of the intervention. OBJECTIVE This systematic review evaluates the methodological quality of existing studies on the LP and collates and reviews its reported efficacy. DATA SOURCES Five databases, PsycINFO, PubMed, CINAHL, Embase, ERIC (to September 2018), and Google and Google Scholar were searched for relevant studies. STUDY SELECTION Studies of the LP in clinical populations published in peer-reviewed journals or in grey literature were selected. Reviews, editorial articles and studies/surveys with un-reported methodology were excluded. DATA EXTRACTION Searches returned 568 records, 21 were retrieved in full text of which 14 fulfilled the inclusion criteria (ten quantitative studies/surveys and four qualitative studies). DATA SYNTHESIS AND CONCLUSIONS The review identified variance in the quality of studies across time; earlier studies demonstrated a lack of control groups, a lack of clarity of aspects of the methodology and potential sampling bias. Although it found a variance in reported patient outcomes, the review also identified an emerging body of evidence supporting the efficacy of the LP for many participants with fatigue, physical function, pain, anxiety and depression. It concludes that there is a need for more randomised controlled trials to evaluate if these positive outcomes can be replicated and generalised to larger populations.
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Affiliation(s)
- P Parker
- School of Psychology, London Metropolitan University, 166-220 Holloway Rd, N78DB, UK.
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15
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Jansson MM, Harjumaa M, Puhto A, Pikkarainen M. Patients’ satisfaction and experiences during elective primary fast‐track total hip and knee arthroplasty journey: A qualitative study. J Clin Nurs 2019; 29:567-582. [DOI: 10.1111/jocn.15121] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 10/04/2019] [Accepted: 11/19/2019] [Indexed: 12/22/2022]
Affiliation(s)
- Miia Marika Jansson
- Research Group of Medical Imaging Physics and Technology University of Oulu Oulu Finland
- Oulu University Hospital Oulu Finland
| | | | - Ari‐Pekka Puhto
- Division of Operative Care Department of Orthopaedic and Trauma Surgery Oulu University Hospital Oulu Finland
| | - Minna Pikkarainen
- Research Group of Medical Imaging Physics and Technology University of Oulu Oulu Finland
- VTT Technical Research Centre of Finland Oulu Finland
- Martti Ahtisaari Institute Oulu Business School Oulu University Oulu Finland
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16
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Al Dandan HB, Galvin R, McClurg D, Coote S. Management strategies for lower urinary tract symptoms (LUTS) among people with multiple sclerosis (MS): a qualitative study of the perspectives of people with MS and healthcare professionals. HRB Open Res 2019; 2:31. [PMID: 32296749 PMCID: PMC7140768 DOI: 10.12688/hrbopenres.12960.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2019] [Indexed: 11/20/2022] Open
Abstract
Background: Neurogenic lower urinary tract dysfunction (NLUTD) is defined as a lower urinary tract dysfunction secondary to confirmed pathology of the nervous system. NLUTD is common in people with multiple sclerosis (MS), with prevalence estimates ranging from 49% to 92%. Managing NLUTD is complex and can be comprised of pharmacological and non-pharmacological interventions. Qualitative research exploring perspectives of people with MS and healthcare professionals on living with and managing NLUTD symptoms is sparse. This study aims to explore the perspectives of people with MS and healthcare professionals on managing NLUTD symptoms. Methods: A qualitative descriptive approach will be applied in this study using audio-recorded semi structured interviews for people with MS and healthcare professionals. The Consolidated Criteria for Reporting Qualitative Studies (COREQ) guidelines will be used to standardize the conduct and reporting of the research. People with MS will be recruited through a gatekeeper at MS Ireland. Healthcare professionals will be recruited through gatekeepers at Irish Practice Nurses Association, Continence Foundation of Ireland, Irish Society of Chartered Physiotherapists, and Physiotherapists Interested in MS Group. Interviews will be transcribed and exported to NVivo software package (Version 12) for analysis. Data will be collectively synthesised using thematic analysis. Conclusion: It is anticipated that exploring perspectives of people with MS and healthcare professionals on managing symptoms (including current practice) of NLUTD in MS will assist in the development of an evidence-based and stakeholder informed intervention for NLUTD in people with MS.
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Affiliation(s)
- Hawra B. Al Dandan
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
- Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Rose Galvin
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
- Aging Research Centre, University of Limerick, Limerick, Ireland
| | - Doreen McClurg
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Susan Coote
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
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Andersson N, Silver H. Fuzzy cognitive mapping: An old tool with new uses in nursing research. J Adv Nurs 2019; 75:3823-3830. [PMID: 31486102 DOI: 10.1111/jan.14192] [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: 04/09/2019] [Revised: 07/15/2019] [Accepted: 08/28/2019] [Indexed: 11/28/2022]
Abstract
AIMS Describe the implementation and uses of fuzzy cognitive mapping (FCM) as a constructive method for meeting the unique and rapidly evolving needs of nursing inquiry and practice. DESIGN Discussion paper. DATA SOURCES Drawing on published scholarship of cognitive mapping from the fields of ecological management, information technology, economics, organizational behaviour and health development, we consider how FCM can contribute to contemporary challenges and aspirations of nursing research. IMPLICATIONS FOR NURSING Fuzzy cognitive mapping can generate theory, describe knowledge systems in comparable terms and inform questionnaire design and dialogue. It can help build participant-researcher partnerships, elevate marginalized voices and facilitate intercultural dialogue. As a relatively culturally safe and foundational approach in participatory research, we suggest that FCM should be used in settings of transcultural nursing, patient engagement, person- and family-centred care and research with marginalized populations. FCM is amenable to rigorous analysis and simultaneously allows for greater participation of stakeholders. CONCLUSION In highly complex healthcare contexts, FCM can act as a common language for defining challenges and articulating solutions identified within the nursing discipline. IMPACT There is a need to reconcile diverse sources of knowledge to meeting the needs of nursing inquiry. FCM can generate theory, describe knowledge systems, facilitate dialogue and support questionnaire design. In its capacity to engage multiple perspectives in defining problems and identifying solutions, FCM can contribute to advancing nursing research and practice.
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Affiliation(s)
- Neil Andersson
- CIET-Participatory Research at McGill, Faculty of Medicine, McGill University, Montreal, QC, Canada.,Centro de Investigación de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Acapulco, México
| | - Hilah Silver
- Department of Family Medicine, Faculty of Medicine, McGill University, Montreal, QC, Canada
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McGill B, O'Hara BJ, Grunseit AC, Bauman A, Lawler L, Phongsavan P. Healthy Weight for Life programme: Evaluating the practice and effectiveness of a weight loss maintenance programme in the private health insurance setting. SAGE Open Med 2019; 7:2050312119873814. [PMID: 31516705 PMCID: PMC6719468 DOI: 10.1177/2050312119873814] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 08/13/2019] [Indexed: 02/05/2023] Open
Abstract
Background Australian private health insurers are increasingly involved in the delivery of chronic disease management programmes to their members, recognising the importance of decreasing and managing lifestyle risk factors and the impact such factors have on health service utilisation. One such secondary prevention programme is the Healthy Weight for Life programme, an intensive weight loss and lifestyle modification programme that has been designed for overweight and obese private health insurance members in Australia. Together with the insurer, the Healthy Weight for Life service provider developed and implemented a long-term maintenance programme that supports participants who complete the Healthy Weight for Life programme to maintain the weight loss they achieved during the programme. Various studies have shown that evidence-based weight management programmes can be effective; however, the results may vary in different contexts. Objective This article presents the evaluation rationale and framework designed to assess the process and impact of the long-term maintenance programme on weight loss maintenance, other health-related benefits and participants' experience with the programme. Methods The evaluation will comprise a number of inter-related sub-studies balancing evaluation of programme effectiveness and implementation. The maintenance programme presented a unique opportunity for researchers to partner with private health insurance and a service provider to assess a real-world programme in the under-researched area of weight loss maintenance in this setting and emphasises the importance of evaluating such programmes given the potential the private health insurance context has in the future delivery of health care.
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Affiliation(s)
- Bronwyn McGill
- The University of Sydney, Sydney School of Public Health, Prevention Research Collaboration, Charles Perkins Centre, Camperdown, NSW, Australia.,The Australian Prevention Partnership Centre, Ultimo, NSW, Australia
| | - Blythe J O'Hara
- The University of Sydney, Sydney School of Public Health, Prevention Research Collaboration, Charles Perkins Centre, Camperdown, NSW, Australia
| | - Anne C Grunseit
- The University of Sydney, Sydney School of Public Health, Prevention Research Collaboration, Charles Perkins Centre, Camperdown, NSW, Australia.,The Australian Prevention Partnership Centre, Ultimo, NSW, Australia
| | - Adrian Bauman
- The University of Sydney, Sydney School of Public Health, Prevention Research Collaboration, Charles Perkins Centre, Camperdown, NSW, Australia.,The Australian Prevention Partnership Centre, Ultimo, NSW, Australia
| | - Luke Lawler
- Prima Health Solutions, Warringah Mall, NSW, Australia
| | - Philayrath Phongsavan
- The University of Sydney, Sydney School of Public Health, Prevention Research Collaboration, Charles Perkins Centre, Camperdown, NSW, Australia
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Dale CM, Angus JE, Sutherland S, Dev S, Rose L. Exploration of difficulty accessing the mouths of intubated and mechanically ventilated adults for oral care: A video and photographic elicitation study. J Clin Nurs 2019; 29:1920-1932. [PMID: 31342565 DOI: 10.1111/jocn.15014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 07/02/2019] [Accepted: 07/09/2019] [Indexed: 02/03/2023]
Abstract
AIM To explore descriptors of difficulty accessing the mouths of intubated and mechanically ventilated adults for oral care, consequences, modifiable antecedents and recommendations for improving care delivery. BACKGROUND Nurses report oral access and care delivery difficulty in most mechanically ventilated patients. DESIGN A prospective qualitative descriptive design. METHODS Data were collected using video and photographic elicitation interviews focused on delivery of oral care. Directed content analysis was used to explore descriptive categories. Reporting used the SRQR guidelines. SETTING AND PARTICIPANTS A university-affiliated hospital in Toronto, Canada. Participants included clinicians experienced in accessing the oral space of adults representing nursing, medicine, dentistry and allied health professionals. FINDINGS We recruited 18 participants; 9 representing critical care and 9 other specialties frequently accessing the mouth, that is dentistry. Descriptors for observed difficulty accessing the oral cavity were "oral crowding with tubes" and "aversive patient responses", which were considered to result in insufficient oral care. Participants perceived aversive patient responses (e.g. biting, turning head side to side, gagging, coughing) as a consequence of forced introduction of instruments inside a crowded mouth. A key finding identified by participants was the observation of substantial procedural pain during oral care interventions. Potentially modifiable antecedents to difficult oral care delivery identified were procedural pain, oral health deterioration (e.g. xerostomia) and lack of interprofessional team problem-solving. Recommendations to address these antecedents included patient preparation for oral care through verbal and nonverbal cueing, pharmacological and nonpharmacological strategies, and ICU interprofessional education. CONCLUSIONS Oral care in mechanically ventilated adults is complex and painful. Visual research methods offer important advantages for oral care exploration including its ability to reveal less visible aspects of the nurse-patient encounter, thereby enabling novel insights and care. RELEVANCE FOR CLINICAL PRACTICE Interprofessional education and training in oral health and care interventions tailored to mechanically ventilated patients are recommended.
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Affiliation(s)
- Craig M Dale
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.,Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Jan E Angus
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Susan Sutherland
- Department of Dentistry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Shelly Dev
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Louise Rose
- Lawrence S. Bloomberg Faculty of Nursing and Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Critical Care Medicine, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College, London, UK
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20
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Social disparities and symptom burden in populations with advanced cancer: specialist palliative care providers' perspectives. Support Care Cancer 2019; 27:4733-4744. [PMID: 30972644 DOI: 10.1007/s00520-019-04726-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 03/01/2019] [Indexed: 10/27/2022]
Abstract
Disparities in access to palliative care services for populations with social disparities have been reported in Western countries. Studies indicate that these populations tend to report higher symptom distress than other population groups. We need to further investigate how social disparities influence symptom burden to improve symptom relief in these populations. PURPOSE To examine the perspectives of specialist palliative care providers concerning the relationship between social disparities and symptom burden in populations with advanced cancer. METHODS Two sequential qualitative studies that followed a combination of interpretive and critical methodologies. The interpretive approach was outlined by van Manen's hermeneutic phenomenology while the critical component was informed by the works of Paulo Freire. Participants involved two specialist palliative care teams from a large acute care hospital and a large cancer center in Western Canada. Participants included 11 palliative care providers including registered nurses, nurse practitioners, physicians, and pharmacists. RESULTS Participants perceived that social conditions that might aggravate symptom burden included low income, low education, lack of social support, language barriers, and rurality. The relationship between income and symptom burden reflected diverse views. Participants identified populations prone to complex symptom burden including homeless individuals, Indigenous people, people with a history of addictions, and people with mental health or psychosocial issues. CONCLUSION Participants perceived that social disparities may increase symptom complexity in populations with advanced cancer. Participants did not identify ethnicity and gender as influencing symptom burden. Further research is needed to examine the interactions of social disparities, patient individuality, and symptom burden.
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21
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Imanipour M, Kiwanuka F, Akhavan Rad S, Masaba R, Alemayehu YH. Family members' experiences in adult intensive care units: a systematic review. Scand J Caring Sci 2019; 33:569-581. [PMID: 30866085 DOI: 10.1111/scs.12675] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 02/03/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Admission to Intensive Care Units (ICU) exposures family members to a new environment, advanced monitoring systems and aggressive treatments. This is coupled with the critical condition of the patient being admitted in ICU. In such times of stress and crisis, families have varying experiences as they navigate the ICU journey. These happen more or less in chronological phases. AIM This review sought to describe the experiences of family members of patients admitted in adult ICUs. DATA SOURCES Four electronic databases (PubMed, Embase, Scopus and Web of Science) were searched, using keywords and free-text words. METHODS Curation of the review question involved problem identification, a scoping search, developing a search strategy, evaluation, data analysis, and reporting. Freehand search in reference lists of eligible articles was also done to obtain potentially eligible articles published in English language between 2007 and 2018. Studies were included if they reported on family members' experiences in adult ICUs. This review conforms to the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA). RESULTS Upon completion of the screening process, 28 studies were included. Most studies were conducted in the United States while no study was identified from Africa. We report on 717 family members. Family members' experience of the ICU journey falls into three main themes: (i) Floating, (ii) Probing and (iii) Continuity or Closure. CONCLUSION As healthcare technology advances, the ICU environment consequently needs to evolve. As such, healthcare providers will need to adjust their practice, support and consider the patients' family as the other part of the patient and members of the care team in order to meet their expectations. Further research highlighting family members' experience of the ICU journey in Africa is needed.
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Affiliation(s)
- Masoomeh Imanipour
- Nursing and Midwifery Care Research Center.,Department of Critical Care Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Frank Kiwanuka
- Department of critical care nursing, School of nursing and midwifery, International Campus, Tehran University of Medical Sciences (IC-TUMS), Tehran, Iran
| | | | - Ronald Masaba
- School of Nursing, Clarke International University, Kampala, Uganda
| | - Yisak Hagos Alemayehu
- Department of critical care nursing, School of nursing and midwifery, International Campus, Tehran University of Medical Sciences (IC-TUMS), Tehran, Iran.,Ayder Comprehensive Specialized Hospital, Mekelle University College of Health Sciences, Mekelle, Ethiopia
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22
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Burnet L. Local implementation of a national curriculum and competency framework for emergency nursing: a review of the evidence. Emerg Nurse 2019; 27:32-36. [PMID: 31468804 DOI: 10.7748/en.2019.e1898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2018] [Indexed: 04/29/2023]
Abstract
This article reviews the evidence associated with the Royal College of Nursing ( 2017 ) Emergency Care Association National Curriculum and Competency Framework for Emergency Nursing to inform the process of implementation in an emergency department. The search for evidence was guided by questions designed to reveal implications relevant to implementation of the framework. Implications identified include a need to let stakeholders know the evidence base is mostly expert opinion, clarify the terms 'competence' and 'competencies' and address concerns about validity and reliability of competency-based assessment. These implications should enhance the progress of the implementation project.
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Affiliation(s)
- Laura Burnet
- Emergency department, King's College Hospital NHS Foundation Trust, London, England
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Stifter J, Sousa VEC, Febretti A, Dunn Lopez K, Johnson A, Yao Y, Keenan GM, Wilkie DJ. Acceptability of Clinical Decision Support Interface Prototypes for a Nursing Electronic Health Record to Facilitate Supportive Care Outcomes. Int J Nurs Knowl 2018; 29:242-252. [PMID: 28926204 PMCID: PMC5858953 DOI: 10.1111/2047-3095.12178] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 04/13/2017] [Accepted: 04/19/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE To determine the acceptability, usefulness, and ease of use for four nursing clinical decision support interface prototypes. METHODS In a simulated hospital environment, 60 registered nurses (48 female; mean age = 33.7 ± 10.8; mean years of experience = 8.1 ± 9.7) participated in a randomized study with four study groups. Measures included acceptability, usefulness, and ease of use scales. FINDINGS Mean scores were high for acceptability, usefulness, and the ease of use for all four groups. Inexperienced participants (<1 year) reported higher perceived ease of use (p = .05) and perceived usefulness (p = .01) than those with experience of 1 year or more. CONCLUSIONS Participants completed the protocol and reported that all four interfaces, including the control (HANDS), were acceptable, easy to use, and useful. IMPLICATIONS FOR NURSING KNOWLEDGE Further study is warranted before clinical implementation within the electronic health record.
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Affiliation(s)
| | | | | | | | - Andrew Johnson
- Associate Professor and Director of Research at the Electronic Visualization Laboratory, Department of Computer Science, College of Engineering
| | - Yingwei Yao
- Research Associate Professor at the College of Nursing, University of Illinois at Chicago, Chicago, Illinois, and at the College of Nursing, University of Florida, Gainesville, Florida
| | - Gail M Keenan
- Adjunct Professor at the College of Nursing, University of Illinois at Chicago, Chicago, Illinois, and the Annabel Davis Jenks Endowed Professor for Teaching and Research in Nursing Clinical Excellence at the College of Nursing, University of Florida, Gainesville, Florida
| | - Diana J Wilkie
- Adjunct Professor at the College of Nursing, University of Illinois at Chicago, Chicago, Illinois, and Professor at Prairieview Trust - Earl and Margo Powers Endowed Professor, and Director of the Academic Center of Excellence in Palliative Care Research and Education, College of Nursing, University of Florida, Gainesville, Florida
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24
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Islam T, Hutchinson AM, Bucknall TK. Nurse manager risk information management for decision-making: A qualitative analysis. Collegian 2018. [DOI: 10.1016/j.colegn.2017.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Santacroce SJ, Leeman J, Song MK. A training program for nurse scientists to promote intervention translation. Nurs Outlook 2018; 66:149-156. [PMID: 29096876 PMCID: PMC5858986 DOI: 10.1016/j.outlook.2017.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 09/04/2017] [Accepted: 09/10/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND To reduce the burden of chronic illness, prevention and management interventions must be efficacious, adopted and implemented with fidelity, and reach those at greatest risk. Yet, many research-tested interventions are slow to translate into practice. PURPOSE This paper describes how The University of North Carolina at Chapel Hill School of Nursing's NINR-funded institutional pre- and postdoctoral research-training program is addressing the imperative to speed knowledge translation across the research cycle. METHODS The training emphasizes six research methods ("catalysts") to speed translation: stakeholder engagement, patient-centered outcomes, intervention optimization and sequential multiple randomized trials (SMART), pragmatic trials, mixed methods approaches, and dissemination and implementation science strategies. Catalysts are integrated into required coursework, biweekly scientific and integrative seminars, and experiential research training. Trainee and program success is evaluated based on benchmarks applicable to all PhD program students, supplemented by indicators specific to the catalysts. Trainees must also demonstrate proficiency in at least two of the six catalysts in their scholarly products. Proficiency is assessed through their works in progress presentations and peer reviews at T32 integrative seminars. DISCUSSION While maintaining the emphasis on theory-based interventions, we have integrated six catalysts into our ongoing research training to expedite the dynamic process of intervention development, testing, dissemination and implementation. CONCLUSIONS Through a variety of training activities, our research training focused on theory-based interventions and the six catalysts will generate future nurse scientists who speed translation of theory-based interventions into practice to maximize health outcomes for patients, families, communities and populations affected by chronic illness.
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Affiliation(s)
- Sheila Judge Santacroce
- School of Nursing, The University of North Carolina at Chapel Hill, Carrington Hall, Chapel Hill, NC.
| | - Jennifer Leeman
- School of Nursing, The University of North Carolina at Chapel Hill, Carrington Hall, Chapel Hill, NC
| | - Mi-Kyung Song
- School of Nursing, The University of North Carolina at Chapel Hill, Carrington Hall, Chapel Hill, NC
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Acosta AM, Oelke ND, Lima MADDS. CONSIDERAÇÕES TEÓRICAS DO DIÁLOGO DELIBERATIVO: CONTRIBUIÇÕES PARA PRÁTICA, POLÍTICA E PESQUISA EM ENFERMAGEM. ACTA ACUST UNITED AC 2018. [DOI: 10.1590/0104-07072017000520017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
RESUMO Objetivo: este estudo visa discutir e refletir sobre concepções teóricas e metodológicas no uso do diálogo deliberativo e sua contribuição para prática, política e pesquisa em enfermagem. Método: foi realizado estudo teórico e reflexivo sobre a abordagem metodológica do processo de deliberação e suas concepções teóricas. O artigo também fornece uma descrição geral das principais características e passos fundamentais que podem ser utilizados para guiar o desenvolvimento uma sessão de deliberação. Resultados: diálogo deliberativo envolve conversações propositadas e facilitadas entre pessoas interessadas para alcançar consenso sobre prioridades em serviços de saúde e decidir coletivamente sobre estratégias para ação utilizando síntese de evidências de pesquisas e experiência contextual. É uma estratégia de translação de conhecimento que envolve indivíduos, comunidades e instituições no uso de conhecimento científico para realizar mudanças fundamentadas. As principais características desse método são seleção cuidadosa dos participantes, elaboração de documento de leitura com síntese de evidências, facilitação neutra e habilidosa, uso de abordagens inovadoras para atividades grupais e análise de dados com métodos integrados. Conclusão: princípios de diálogo deliberativo têm sido utilizados para a tomada de decisão política, com pouco uso nos cuidados de enfermagem. Seu uso pode ser uma experiência única para o campo de enfermagem, contribuindo para mudanças nas práticas e políticas. Também pode ser utilizado como estratégia para coleta dados em pesquisa qualitativa, como uma nova forma de construir conhecimento científico. Diálogo deliberativo é uma abordagem inovadora que pode proporcionar enfermeiros mais críticos-reflexivos, mais práticas baseadas em evidências e melhores resultados de saúde.
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Understanding Early Decisions to Withdraw Life-Sustaining Therapy in Cardiac Arrest Survivors. A Qualitative Investigation. Ann Am Thorac Soc 2018; 13:1115-22. [PMID: 27073975 DOI: 10.1513/annalsats.201511-751oc] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
RATIONALE Early withdrawal of life-sustaining therapy contributes to the majority of deaths following out-of-hospital cardiac arrest (OHCA), despite current recommendations for delayed neurological prognostication (≥72 h) after treatment with targeted temperature management. Little is known about clinicians' experiences of early withdrawal of life support decisions in patients with OHCA. OBJECTIVES To explore clinicians' experiences and perceptions of early withdrawal of life support decisions and barriers to guideline-concordant neurological prognostication in comatose survivors of OHCA treated with targeted temperature management. METHODS We conducted qualitative interviews with intensive care unit (ICU) physicians and nurses following withdrawal of life support in comatose patients with OHCA treated with targeted temperature management. The study was carried out across 18 academic and community hospitals participating in a multicenter, stepped-wedge, cluster-randomized controlled trial designed to improve quality-of-care processes for patients after OHCA in Ontario, Canada. We used a focused thematic analysis to capture barriers to guideline-concordant neurological prognostication and used these barriers to identify potentially modifiable issues. MEASUREMENTS AND MAIN RESULTS The core thematic finding was a high emotional burden of ICU family-team communication in which strong feelings inhibited information transfer and delayed decision making following OHCA. Four subthemes describing sources of communication strain were identified: (1) requests from family members to provide early outcome predictions, (2) incomplete family comprehension of critical care, (3) family requests for early withdrawal of life support based on their understanding of patients' preferences and values, and (4) family-team communication gaps related to prognostic uncertainty. Participants worried that gaps in timely and clear prognostic information contributed to surrogates' perceptions of a poor outcome and to inappropriately early decisions to withdraw life support. CONCLUSIONS Family-team communication difficulties may be an underestimated factor leading to early withdrawal of life support in ICUs for individuals who initially survive OHCA.
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Tan K, Black BP. A Systematic Review of Health Care Provider-Perceived Barriers and Facilitators to Routine HIV Testing in Primary Care Settings in the Southeastern United States. J Assoc Nurses AIDS Care 2017; 29:357-370. [PMID: 29331504 DOI: 10.1016/j.jana.2017.12.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 12/18/2017] [Indexed: 10/18/2022]
Abstract
Despite efforts to improve HIV screening and testing, many primary care settings do not follow established guidelines. The purpose of our systematic review was to describe health care providers' perceived barriers and facilitators to testing for HIV at poorly used/novel testing sites in the southeastern United States. PubMed, CINAHL, and Embase databases were searched for peer-reviewed studies of providers' perceived barriers and facilitators to routine HIV testing from January 2016 to April 2017 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Of 708 papers retrieved, 12 met inclusion criteria and were analyzed. Barriers to HIV testing in primary care existed at the societal, organizational, and individual levels. Providers need continuing sexual health education, including HIV and federal guideline updates, and students should have clinical experiences to supplement knowledge about sexual health. Clinic protocols should be updated to meet current policy guidelines.
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Polancich S, Roussel L, Graves BA, O'Neal PV. A regional consortium for doctor of nursing practice education: Integrating improvement science into the curriculum. J Prof Nurs 2017; 33:417-421. [DOI: 10.1016/j.profnurs.2017.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 07/25/2017] [Indexed: 10/19/2022]
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Engaging national and regional partners to accelerate broad-scale implementation of nurse-developed interventions. Nurs Outlook 2017; 66:18-24. [PMID: 28951005 DOI: 10.1016/j.outlook.2017.08.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 08/13/2017] [Accepted: 08/27/2017] [Indexed: 11/21/2022]
Abstract
Only a small proportion of research-tested interventions translate into broad-scale implementation in real world practice, and when they do, it often takes many years. Partnering with national and regional organizations is one strategies that researchers may apply to speed the translation of interventions into real-world practice. Through these partnerships, researchers can promote and distribute interventions to the audiences they want their interventions to reach. In this paper, we describe five nurse scientists' programs of research and their partnerships with networks of national, regional, and local organizations, including their initial formative work, activities to engage multi-level network partners, and lessons learned about partnership approaches to speeding broad-scale implementation.
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Mother's Lived Experience During Repair of Long-Gap Esophageal Atresia: A Phenomenological Inquiry. Adv Neonatal Care 2017; 17:313-323. [PMID: 28570293 DOI: 10.1097/anc.0000000000000415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Infants born with long-gap esophageal atresia (LGEA) pose unique physiologic risks in the newborn period. Anatomic and physiologic anomalies require an extended hospitalization with procedural analgesia and sedation that impact the mother's experience of birth, maternal response, and nurturing of her infant. PURPOSE The aim of this study was to understand the meaning of experiences that mothers of infants born with LGEA encounter in the neonatal intensive care unit while their infant undergoes esophageal repair. METHODS A hermeneutical phenomenological design was used to guide this inquiry. Three mothers were interviewed on 3 separate occasions. The conversations were audio-recorded and transcribed verbatim. The findings were analyzed using fundamental existential lifeworld themes. RESULTS The essence that conceptualized the study was "making connections: day-by-day." Themes that emerged are (a) the many phases; (b) the long and winding road; (c) a new me, my purpose; and (d) our new community. IMPLICATIONS FOR PRACTICE Nurses' knowledge and understanding of maternal experiences of having an infant with LGEA will enable for increased physical closeness, optimizing time spent together to learn their infant's unique personality. Creating partnerships with mothers can enhance our understanding of their perspectives, concerns, needs, and guide interventions. IMPLICATIONS FOR RESEARCH Further exploration of family dynamics including fathers, siblings, and contextual factors may illuminate interventions to enhance relationships and communication that may influence developmental outcomes for families of infants with LGEA.
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Brown EG, Josephson SA, Anderson N, Reid M, Lee M, Douglas VC. Predicting inpatient delirium: The AWOL delirium risk-stratification score in clinical practice. Geriatr Nurs 2017; 38:567-572. [PMID: 28533062 DOI: 10.1016/j.gerinurse.2017.04.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 04/08/2017] [Accepted: 04/17/2017] [Indexed: 12/21/2022]
Abstract
Inpatient delirium improves with multicomponent interventions by hospital staff, though the resources needed are often limited. Risk-stratification to predict delirium is a useful first step to help triage resources, but the performance of risk-stratification as part of a functioning multicomponent pathway has not been assessed. We retrospectively studied the performance of a validated delirium prediction rule, the AWOL score, as a part of a multicomponent delirium care pathway in practice on a university hospital ward. We reviewed the hospitalizations of patients 50 years or older for evidence of delirium and extracted the AWOL score from nursing documentation (n = 347). The area under the receiver operating characteristic curve (AUC) was 0.83 (95% CI 0.77-0.89) for all cases and 0.73 (95% CI 0.60-0.85) when cases of prevalent delirium were removed. Involving minimal additional assessment, this nursing-based risk stratification score performed well as part of a multicomponent delirium care pathway.
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Affiliation(s)
- Ethan G Brown
- Department of Neurology, University of California, San Francisco, USA.
| | | | - Noriko Anderson
- Department of Neurology, University of California, Irvine, USA
| | - Mary Reid
- Department of Neurology, University of California, San Francisco, USA
| | - Melissa Lee
- Department of Neurology, University of California, San Francisco, USA
| | - Vanja C Douglas
- Department of Neurology, University of California, San Francisco, USA.
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Kerns JW, Winter JD, Winter KM, Kerns CC, Etz RS. Caregiver Perspectives About Using Antipsychotics and Other Medications for Symptoms of Dementia. THE GERONTOLOGIST 2017; 58:e35-e45. [DOI: 10.1093/geront/gnx042] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 03/24/2017] [Indexed: 01/22/2023] Open
Affiliation(s)
- John William Kerns
- VCU-Shenandoah Valley Family Practice Residency, Front Royal, Virgina
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond
| | - Jonathan D Winter
- VCU-Shenandoah Valley Family Practice Residency, Front Royal, Virgina
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond
| | | | - Christine C Kerns
- VCU-Shenandoah Valley Family Practice Residency, Front Royal, Virgina
| | - Rebecca S Etz
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond
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Participatory simulation modelling to inform public health policy and practice: Rethinking the evidence hierarchies. J Public Health Policy 2017; 38:203-215. [DOI: 10.1057/s41271-016-0061-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Sibbern T, Bull Sellevold V, Steindal SA, Dale C, Watt-Watson J, Dihle A. Patients’ experiences of enhanced recovery after surgery: a systematic review of qualitative studies. J Clin Nurs 2017; 26:1172-1188. [DOI: 10.1111/jocn.13456] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2016] [Indexed: 12/19/2022]
Affiliation(s)
- Tonje Sibbern
- Diakonhjemmet University College; Institute of Nursing and Health; Oslo Norway
| | | | - Simen A Steindal
- Diakonhjemmet University College; Institute of Nursing and Health; Oslo Norway
- Lovisenberg Diaconal University College; Oslo Norway
| | - Craig Dale
- Lawrence S. Bloomberg Faculty of Nursing; University of Toronto; Toronto ON Canada
| | - Judy Watt-Watson
- Lawrence S. Bloomberg Faculty of Nursing; University of Toronto; Toronto ON Canada
| | - Alfhild Dihle
- Diakonhjemmet University College; Institute of Nursing and Health; Oslo Norway
- Oslo and Akershus University College of Applied Sciences; Oslo Norway
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Abstract
The concept of the patient experience as it relates to patient satisfaction is a complex dynamic. It is a dynamic that is becoming increasingly more important as patients are faced with multiple choices for their hearing and balance care. As reimbursement and performance policies have become more normative within health care, patient satisfaction has become a metric to measure quality. Patient satisfaction is no longer contained to just the interaction with the audiologist. It extends to the entire experience-the staff, the service, the product, and other factors. Many practices fail to capitalize on one of the primary components of the patient experience-office design. This article discusses the role of evidence-based design in facility planning as it relates to patient satisfaction. It will illustrate how design principles and ideal attributes may be used to send conscious and subconscious cues that will motivate staff, facilitate patient-centered care, and ultimately increase patient satisfaction.
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Affiliation(s)
- Karen Jacobs
- Private Practice, AVA Hearing Center, Grand Rapids, Michigan
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Abstract
The doctor of nursing practice (DNP) degree was formalized in 2004. Data evaluating the impact of DNP-prepared nurses on individual patient care, population health, and healthcare system outcomes are limited. This article demonstrates how the DNP Essentials can be used to frame DNP program evaluation data.
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Affiliation(s)
- Ursula A Pritham
- Ursula A. Pritham is an assistant professor at Georgia Southern University, School of Nursing, Statesboro, Ga. Patricia White is a professor and practice director of the DNP Program School of Nursing and Health Sciences Nursing Programs at Simmons College, Boston, Mass
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Voldbjerg SL, Grønkjaer M, Sørensen EE, Hall EO. Newly graduated nurses’ use of knowledge sources: a meta-ethnography. J Adv Nurs 2016; 72:1751-65. [DOI: 10.1111/jan.12914] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Siri Lygum Voldbjerg
- Department of Nursing; University College of Northern Denmark; Aalborg Denmark
- Clinical Nursing Research Unit; Aalborg University Hospital; Aalborg Denmark
| | - Mette Grønkjaer
- Clinical Nursing Research Unit; Aalborg University Hospital; Aalborg Denmark
| | - Erik Elgaard Sørensen
- Clinical Nursing Research Unit; Aalborg University Hospital; Aalborg Denmark
- Department of Clinical Medicine; Aalborg University; Aalborg Denmark
| | - Elisabeth O.C. Hall
- Section of Nursing; Department of Public Health, Health; Aarhus University; Aalborg Denmark
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Grudniewicz A, Bhattacharyya O, McKibbon KA, Straus SE. User-Centered Design and Printed Educational Materials: A Focus Group Study of Primary Care Physician Preferences. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2016; 36:249-255. [PMID: 28350305 DOI: 10.1097/ceh.0000000000000112] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION It is challenging for primary care physicians (PCPs) to review and apply the growing amount of clinical evidence available. Printed educational materials (PEMs), which synthesize evidence, are often ineffective at improving knowledge, possibly due to poor design and limited uptake. In this study, we collected PCP preferences for the design and content of physician-oriented PEMs and determined key attributes that may increase their usability and uptake. METHODS We held 90-minute focus groups with PCPs in Toronto, ON, Canada. Focus groups included discussion about whether and how participants use PEMs, feedback on three examples of PEMs, and a discussion on general format and design preferences in PEMs. We analyzed focus group transcripts using a thematic analysis and summarized results in a list of user preferences. RESULTS Four focus groups were held with 13 PCPs. We found that participants only read PEMs relevant to their patients and prefer short, concise documents, with links to sources that can provide more detailed information. Simplicity of materials was important, with many participants preferring PEMs without lengthy backgrounds or scientific explanations. Most participants wanted to see key messages highlighted to easily assess the relevance of the materials to their practice. Some participants shared physician-oriented PEMs with patients. DISCUSSION This study shows that PCPs may prefer shorter, simpler, and more concise documents that have less scientific detail but provide references to further information sources. It is important to understand end user preferences for the design and content of these materials to enhance their uptake.
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Affiliation(s)
- Agnes Grudniewicz
- Dr. Grudniewicz: Assistant Professor, Telfer School of Management, University of Ottawa, Ottawa, Ontario, Canada. Dr. Bhattacharyya: Senior Scientist, Frigon-Blau Chair in Family Medicine Research, Family Physician, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada, Associate Professor, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada, and Assistant Professor, Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada. Dr. McKibbon: Past Director MSc in eHealth, Health Information Research Unit, Department of Clinical Epidemiology and Biostatistics, McMaster University Faculty of Health Sciences, Communications Research Laboratory, Hamilton, Ontario, Canada. Dr. Straus: Director and Scientist, Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada, Deputy Physician in Chief, St. Michael's Hospital, Toronto, Ontario, Canada, and Professor, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Ng E, de Colombani P. Framework for Selecting Best Practices in Public Health: A Systematic Literature Review. J Public Health Res 2015; 4:577. [PMID: 26753159 PMCID: PMC4693338 DOI: 10.4081/jphr.2015.577] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Accepted: 08/11/2015] [Indexed: 11/23/2022] Open
Abstract
Evidence-based public health has commonly relied on findings from empirical studies, or research-based evidence. However, this paper advocates that practice-based evidence derived from programmes implemented in real-life settings is likely to be a more suitable source of evidence for inspiring and guiding public health programmes. Selection of best practices from the array of implemented programmes is one way of generating such practice-based evidence. Yet the lack of consensus on the definition and criteria for practice-based evidence and best practices has limited their application in public health so far. To address the gap in literature on practice-based evidence, this paper hence proposes measures of success for public health interventions by developing an evaluation framework for selection of best practices. The proposed framework was synthesised from a systematic literature review of peer-reviewed and grey literature on existing evaluation frameworks for public health programmes as well as processes employed by health-related organisations when selecting best practices. A best practice is firstly defined as an intervention that has shown evidence of effectiveness in a particular setting and is likely to be replicable to other situations. Regardless of the area of public health, interventions should be evaluated by their context, process and outcomes. A best practice should hence meet most, if not all, of eight identified evaluation criteria: relevance, community participation, stakeholder collaboration, ethical soundness, replicability, effectiveness, efficiency and sustainability. Ultimately, a standardised framework for selection of best practices will improve the usefulness and credibility of practice-based evidence in informing evidence-based public health interventions. Significance for public healthBest practices are a valuable source of practice-based evidence on effective public health interventions implemented in real-life settings. Yet, despite the frequent branding of interventions as best practices or good practices, there is no consensus on the definition and desirable characteristics of such best practices. Hence, this is likely to be the first systematic review on the topic of best practices in public health. Having a single widely accepted framework for selecting best practices will ensure that the selection processes by different agencies are fair and comparable, as well as enable public health workers to better appreciate and adopt best practices in different settings. Ultimately, standardisation will improve the credibility and usefulness of practice-based evidence to that of research-based evidence.
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Enabling sense-making for patients receiving outpatient palliative treatment: A participatory action research driven model for person-centered communication. Palliat Support Care 2015; 14:212-24. [PMID: 26235481 DOI: 10.1017/s1478951515000814] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES In clinical palliative cancer care, the diversity of patient concerns over time makes information provision a critical issue, the demands of information-seeking patients presenting a challenge to both the communicative and organizational skills of the health provider. This study puts forward a practice model for communication between patients, their family members, and professional health providers during ongoing palliative chemotherapy; a model which supports the providers in enabling person-centered communication. METHOD A constant comparative analysis adapted to participatory action research was applied. The model was developed step-wise in three interrelated cycles, with results from previous studies from palliative cancer care processed in relation to professional health providers' experience-based clinical knowledge. In doing this, focus group discussions were carried out with providers and patients to develop and revise the model. RESULTS The Enabling Sense Making model for person-centered communication gave rise to three domains (which are also the major communicative actors in palliative care): the patient, the family, and the provider. These actors were placed in the context of a communicative arena. The three respective domains were built up in different layers discriminating between significant aspects of person-centered communication, from the manifest that is most usually explicated in dialogues, to the latent that tends to be implicitly mediated. SIGNIFICANCE OF RESULTS The model intends to facilitate timely reorientation of care from curative treatment or rehabilitation to palliation, as well as the introduction of appropriate palliative interventions over time during palliative phases. In this way the model is to be regarded a frame for directing the awareness of the professionals, which focuses on how to communicate and how to consider the patient's way of reasoning. The model could be used as a complement to other strategic initiatives for the advancement of palliative care communication. It needs to be further evaluated in regard to practice evidence.
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When care situations evoke difficult emotions in nursing staff members: an ethnographic study in two Norwegian nursing homes. BMC Nurs 2015; 14:40. [PMID: 26229519 PMCID: PMC4520056 DOI: 10.1186/s12912-015-0093-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 07/23/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Caring practice in nursing homes is a complex topic, especially the challenges of meeting the basic needs of residents when their behaviour evokes difficult emotions. Cognitive and physical changes related to aging and disability can contribute to behaviours considered to be unacceptable. For example, resident behaviours such as spitting, making a mess with food or grinding teeth are behaviours that most people do not want to see, hear or experience. The aim of this study was to gain a deeper understanding of how nursing home staff members deal with such behaviours in care situations. METHODS This article draws on ethnographic data to describe how nursing home staff members manage unpleasant resident behaviours. The study was based on two long-term units in two Norwegian public nursing homes. The Region's Medical Ethics Committee and the Norwegian Social Science Data Services granted approval. In total, 45 participants (37 nursing aides and eight nurses) agreed to participate in this study. Ten of the participants were interviewed at the end of the field study. RESULTS This study indicates that nursing home staff members experience difficult emotions related to some residents' behaviours. However, they found these feelings difficult to express and rarely verbalized them openly. In addition, they were characterized by a strong obligation to help all residents, despite their own feelings. Therefore, it appears that an inner struggle occurs as a part of everyday practice. CONCLUSIONS Despite these difficult emotions, nursing staff members believed that they needed to manage their responses and continued to offer good care to all residents. These findings extend our understanding of this unarticulated part of nursing home practice.
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Kuennen JK. Critical Reflection: A Transformative Learning Process Integrating Theory and Evidence-Based Practice. Worldviews Evid Based Nurs 2015; 12:306-8. [DOI: 10.1111/wvn.12095] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2014] [Indexed: 11/27/2022]
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Ostlund U, Persson C. Examining Family Responses to Family Systems Nursing Interventions: An Integrative Review. JOURNAL OF FAMILY NURSING 2014; 20:259-286. [PMID: 25026964 DOI: 10.1177/1074840714542962] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
To add to the small, but growing, number of literature reviews of family interventions in health care, a systematic literature search of Family Systems Nursing intervention research resulted in the inclusion of 17 empirical research reports. Family Systems Nursing intervention research to date has primarily used qualitative methods and a few quasi-experimental designs using pre-post outcome measures. Families' responses to Family Systems Nursing interventions were categorized in this integrative review using the cognitive, affective, and behavioral domains of family functioning proposed by Wright and Leahey. Family response in the cognitive domain found improved understanding, capability, and enhanced coping. The affective response categories showed caring more about each other and the family, improved family emotional well-being, and improved individual emotional well-being. Finally, family responses in the behavioral domain comprised caring more for each other and the family, improvement in interactions within and outside family, and healthier individual behavior. These findings may guide the design of future family nursing intervention research and the selection of family outcome measures to examine the usefulness of Family Systems Nursing interventions. More intervention research using experimental and quasi-experimental designs is needed to strengthen the evidence for Family Systems Nursing practice.
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Understanding inequalities in access to health care services for aboriginal people: a call for nursing action. ANS Adv Nurs Sci 2014; 37:E1-E16. [PMID: 25102218 DOI: 10.1097/ans.0000000000000039] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
We present findings from an Access Research Initiative to reduce health disparities and promote equitable access with Aboriginal peoples in Canada. We employed Indigenous, interpretive, and participatory research methodologies in partnership with Aboriginal people. Participants reported stories of bullying, fear, intimidation, and lack of cultural understanding. This research reveals the urgent need to enhance the delivery of culturally appropriate practices in emergency. As nurses, if we wish to affect equity of access, then attention is required to structural injustices that act as barriers to access such as addressing the stigma, stereotyping, and discrimination experienced by Aboriginal people in this study.
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Segre LS, Pollack LO, Brock RL, Andrew JR, O'Hara MW. Depression screening on a maternity unit: a mixed-methods evaluation of nurses' views and implementation strategies. Issues Ment Health Nurs 2014; 35:444-54. [PMID: 24857528 DOI: 10.3109/01612840.2013.879358] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Postpartum women often suffer clinically significant depressive symptoms, a problem addressed by nurse-delivered screening programs. In the past, success of these identification programs was measured in terms of screening rates; however, merely evaluating the screening rate does little to inform how to implement depression screening in clinical practice. This article describes the experiences of nurses in implementing depression screening on a maternity unit. We evaluate the practice qualitatively, by asking nurses to describe their screening strategies and their views about implementation, as well as quantitatively by assessing their screening rates and the number of women identified. Utilizing a framework of program evaluation, 20 maternity unit nurses completed qualitative assessments investigating their day-to-day experiences with this practice. To include the perspectives of nurses that declined to participate in qualitative assessments, 14 additional maternity unit nurses completed a brief survey assessing their views. We also assessed screening rates, defined as the number of women screened divided by the number eligible for screening. Maternity unit nurses viewed depression screening positively and were able to screen patients in relatively few steps, which they implemented using strategies they had developed themselves. Despite nurses' ongoing concern about finding time to screen, they achieved high screening rates and, with one exception, indicated they would opt to continue voluntarily. Depression screening on the maternity unit is feasible and embraced by attending nurses. The clinical strategies used to implement screening are extensively described and provide a basis for implementation in other settings that serve perinatal women.
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Affiliation(s)
- Lisa S Segre
- University of Iowa, College of Nursing, Iowa City, Iowa, USA
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Ammerman A, Smith TW, Calancie L. Practice-Based Evidence in Public Health: Improving Reach, Relevance, and Results. Annu Rev Public Health 2014; 35:47-63. [DOI: 10.1146/annurev-publhealth-032013-182458] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Alice Ammerman
- Center for Health Promotion and Disease Prevention,
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina 27599-7426; , ,
| | - Tosha Woods Smith
- Center for Health Promotion and Disease Prevention,
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina 27599-7426; , ,
| | - Larissa Calancie
- Center for Health Promotion and Disease Prevention,
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina 27599-7426; , ,
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48
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Abstract
When appraising research papers, how much understanding is enough? More specifically, in deciding whether research results can inform practice, do appraisers need to substantively understand how findings are derived or is it sufficient simply to grasp that suitable analytic techniques were chosen and used by researchers? The degree or depth of understanding that research appraisers need to attain before findings can legitimately/sensibly inform practice is underexplored. In this paper it is argued that, where knowledge/justified beliefs derived from research evidence prompt actions that materially affect patient care, appraisers have an epistemic duty to demand high (maximal) rather than low (minimal) levels of understanding regards finding derivation (i.e. appraisers have a duty to seek a superior epistemic situation). If this argument holds assumptions about appraiser competence/ability and the feasibility of current UK conceptions of evidence based practice are destabilized.
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Affiliation(s)
- Martin Lipscomb
- Faculty of Health and Life Sciences, University of the West of England, Gloucester, UK
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Wendler MC, Kirkbride G, Wade K, Ferrell L. Translational research: a concept analysis. Res Theory Nurs Pract 2014; 27:214-32. [PMID: 24422334 DOI: 10.1891/1541-6577.27.3.214] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
UNLABELLED BACKGROUND/CONCEPTUAL FRAMEWORK: Little is known about which approaches facilitate adoption and sustainment of evidence-based practice change in the highly complex care environments that constitute clinical practice today. The purpose of this article was to complete a concept analysis of translational research using a modified Walker and Avant approach. DESIGN/DATA COLLECTION: Using a rigorous and thorough review of the recent health care literature generated by a deep electronic search from 2004-2011, 85 appropriate documents were retrieved. Close reading of the articles by three coresearchers yielded an analysis of the emerging concept of translational research. DATA ANALYSIS Using the iterative process described by Walker and Avant, a tentative definition of the concept of translational research, along with antecedents and consequences were identified. Implications for health care professionals in education, practice, and research are offered. Further research is needed to determine the adequacy of the definition, to identify empirical referents, and to guide theory development. RESULTS The study resulted in a theoretical definition of the concept of translational research, along with identification of antecedents and consequences and a description of an ideal or model case to illustrate the definition. IMPLICATIONS/CONCLUSIONS Implications for practice and education include the importance of focusing on translational research approaches that may reduce the research-practice gap in health care, thereby improving patient care delivery. Research is needed to determine the usefulness of the definition in health care clinical practice.
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Affiliation(s)
- M Cecilia Wendler
- Nursing Research and Academic Partnerships, Memorial Medical Center, Springfield, Illinois 62781-0001, USA.
| | - Geri Kirkbride
- Nursing Research and Academic Partnerships, Memorial Medical Center, Springfield, Illinois 62781-0001, USA
| | - Kristen Wade
- Nursing Research and Academic Partnerships, Memorial Medical Center, Springfield, Illinois 62781-0001, USA
| | - Lynne Ferrell
- Nursing Research and Academic Partnerships, Memorial Medical Center, Springfield, Illinois 62781-0001, USA
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Rush WA, Schleyer TK, Kirshner M, Boyle R, Thoele MJ, Lenton P, Asche S, Thyvalikakath T, Spallek H, Durand EC, Enstad CJ, Huntley CL, Rindal DB. Integrating Tobacco Dependence Counseling into Electronic Dental Records: A Multi-Method Approach. J Dent Educ 2014. [DOI: 10.1002/j.0022-0337.2014.78.1.tb05654.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Titus K.L. Schleyer
- Center for Biomedical Informatics; Regenstrief Institute, Inc; Indianapolis IN
| | | | | | | | - P.A. Lenton
- HealthPartners Institute for Education and Research
| | - Steve Asche
- HealthPartners Institute for Education and Research
| | | | | | | | | | - Charles L. Huntley
- Dental Clinic Systems; HealthPartners Institute for Education and Research
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