Choreographing the End of Life in a Neonate

As caregivers, we often have the privilege of accompanying patients and their families at the end of life. When the patients are newborn infants, the parents are totally unprepared cognitively, emotionally, and spiritually. Their experience represents uncharted territory. The concept of uncharted territory probably applies to everyone facing the death of a loved one for the first time for both the patients and their families. Providing some guidance to patient/family dyads, while simultaneously respecting their autonomy, may be helpful to facilitate healing and meaning construction during the process of bereavement. In applying an integrative universal paradigm of care when curative measures elude us, healing measures become of paramount importance. An exemplar involving a neonate is presented in this commentary; however, healing measures are relevant to patients of all ages as well as to their loved ones.

Impact of Education on School-aged Children's Knowledge of and Participation in "The Choking Game"

OBJECTIVES

To better understand school-aged children's awareness of and attitudes about the Choking Game (TCG). To determine if education can increase awareness of the risk of injury when playing TCG and to determine if education can decrease interest in TCG participation.

DESIGN

Anonymous pre- and post-education surveys.

SETTING

Two middle/high schools; one in Utah and one in California.

SUBJECTS

291 participants (163 in Utah, 128 in California) aged 9-18, 68% under age 15, 32% 15 and older; 65% white, 35% non-white; 52% female, 48% male.

RESULTS

76% of participants knew about TCG, of those 62% heard about it at school. 32% knew someone who had played, and twelve (4%) had played, usually with others. Most frequently cited as reasons for participation were curiosity, peer pressure, and competition. School was the most common location for playing. In California education significantly increased risk awareness, and significant positive attitude changes were observed regarding interest in playing TCG. Utah participants also exhibited attitude changes in the desired direction (less interest in playing TCG, would warn friends, and realized it was not safe to stop breathing), although results were not statistically significant, possibly due to previous education and four recent and highly publicized TCG deaths in the community.

CONCLUSION

Results indicate that interactive, standardized, and skills-based education can increase student awareness of TCG risks and decrease interest in participation. Students reported that the schools were often where they first heard about TCG and where TCG was commonly played. Educators and associated health care professionals should therefore be encouraged to provide preventative education as part of school curricula.

Pressure Mapping Comparison of Four OR Surfaces

Mortality and health care costs associated with hospital-acquired pressure ulcers (HAPUs) increase yearly. After four hours of surgery, the risk of developing a pressure ulcer increases by 33% for every 30 minutes of surgery. Prolonged immobility, lower blood pressures, and increased surface interface pressure may hinder the blood supply delivered to the skin, eventually leading to pressure ulcers. We measured and compared four different OR surfaces to identify the most effective pressure redistribution surface for prolonged OR procedures. The best surface attributes that provide efficient pressure redistribution should have the following properties: the lowest average interface pressure, the lowest peak interface pressure, and the highest skin contact area. Although all surfaces had similar average interface pressures, the air-inflated static seat cushion had the best pressure redistribution properties in the sacral region compared with the other surfaces tested.

The effectiveness of psychosocial interventions with cancer patients: an integrative review of the literature (2006-2011)

Background. Previous integrative literature reviews and meta-analyses have yielded conflicting results regarding the effectiveness of psychosocial interventions for cancer patients. Methods. An integrative review of the literature focused on 19 randomized, controlled trials (2006-2011) was completed to examine the effectiveness of psychosocial interventions for cancer patients.

ELIGIBILITY CRITERIA

Inclusion criteria were the study was an English language randomized controlled clinical trial. Results. Seven studies involved nurses. Eleven studies resulted in positive outcomes. Overall, study quality was limited. In eight studies the intervention was not adequately described, 7 studies did not contain a hypothesis, 4 did not include clear eligibility criteria, 10 studies did not randomize appropriately, 9 did not list recruitment dates, 11 did not include a power analysis, 14 did not include blinded patients or data collectors, 11 did not use an intent-to-treat analysis, 10 did not clarify reasons for drop outs, and 11 did not discuss treatment fidelity. Conclusions. Future studies should build on previous findings, use comparable outcome measures, and adhere to standards of quality research. Qualitative studies are needed to determine what cancer patients of varied ages, cancer stages, and racial/ethnic backgrounds believe would be an effective intervention to manage their psychosocial needs.

Using the Mehran risk scoring tool to predict risk for contrast medium-induced nephropathy in patients undergoing percutaneous angiography

BACKGROUND

Patients who have radiological imaging with contrast material are at risk for contrast medium-induced nephropathy, reduced renal function, longer hospitalizations, and renal failure requiring dialysis.

OBJECTIVE

To determine whether the Mehran risk scoring tool can be used to predict changes in hospitalized patients who had percutaneous angiography.

METHODS

Data on 196 patients admitted for cardiac angiography who had Mehran risk scores higher than 6 were analyzed retrospectively. Creatinine levels, used as predictors of contrast medium-induced nephropathy, were evaluated at day 2, day 3, and day 4 through day 7.

RESULTS

Creatinine levels were significantly higher in patients with a Mehran risk score of 11 or higher than in patients with a risk score of 6 to 10 at all times.

CONCLUSIONS

The Mehran risk scoring tool provides reliable data before patients have percutaneous angiography.

Women's voices: attitudes and behaviors of female Ghanaian sex workers regarding HIV prevention and AIDS-related stigma

Attitudes and behaviors of sex workers have a pivotal influence on the spread of AIDS. A qualitative descriptive study was undertaken to elicit Ghanaian female sex workers' perspectives regarding effective methods of HIV prevention, sources of AIDS-related stigma, and challenges associated with sex work. Women described that: (1) sex work is hard; (2) they felt God would protect their health; (3) staying safe is both a gift and a priority; (4) sex work allows for autonomy; and (5) AIDS-related stigma is very real. To design effective prevention programs it is necessary to consider the culture and perspectives of those who will be served.

Registered Nurses’ Views About Work and Retirement

Study purpose: The purpose of this study was to identify what motivates experienced nurses to continue working and to consider retirement. Method: A total of 16 intensive care nurses completed phenomenological interviews. The experienced nurses were split into two groups: 31 to 49 years old (younger nurses) and 50 to 65 years old (older nurses). Results: Both groups expressed that concern about changing benefits and financial security kept them working. The younger nurse group valued working for autonomy and respect, camaraderie with peers, providing for their families, and because their parents influenced retirement perceptions. The older nurse group valued working as a way to connect with patients and families. Experiences that provoked thoughts of retirement in the older group were changes related to new technology. Older nurses did not want to work to the extent that their health was influenced. Application: By designing human resource policies that address the concerns that influence nurse retirement choices, administrators can maximize retention strategies.

The effectiveness of Tai Chi, yoga, meditation, and Reiki healing sessions in promoting health and enhancing problem solving abilities of registered nurses

Given the current necessity of retaining qualified nurses, a self-care program consisting of Yoga, Tai Chi, Meditation classes, and Reiki healing sessions was designed for a university-based hospital. The effectiveness of these interventions was evaluated using self-care journals and analyzed using a Heideggerian phenomenological approach. Outcomes of the self-care classes described by nurses included: (a) noticing sensations of warmth, tingling, and pulsation which were relaxing, (b) becoming aware of an enhanced problem solving ability, and (c) noticing an increased ability to focus on patient needs. Hospitals willing to invest in self-care options for nurses can anticipate patient and work related benefits.

The Use of Knee-Length Versus Thigh-Length Compression Stockings and Sequential Compression Devices

BACKGROUND

Nurses on an Acute Care Evidence Based Practice Committee, creating a policy to increase patient compliance with thromboembolic deterrent stockings (TEDS) and sequential compression devices (SCDs) for deep vein thrombosis prophylaxis, found limited literature on patient preference and response to this treatment.

STUDY AIM

The study purpose was to determine whether knee-length or thigh-length TEDS and/or SCDs were more comfortable, correctly applied, and worn by patients, and to assess patient reasons for noncompliance.

METHOD

A patient survey and observational data tool was designed. Six surveyors collected data (interrater reliability = 93%) from 137 randomly selected patients with orders for TEDS and/or SCDs admitted to acute care medical or surgical nursing units.

RESULTS

Most patients wore thigh-length SCDs and TEDS. However, only 29.2% (n = 40) had SCDs on them at the time of survey, and 62.8% (n = 86) were compliant with TEDS. The most common reasons given for noncompliance with SCDs were that the devices were not reapplied after bathing or ambulating, or were removed because they were hot or itchy. Complaints of discomfort were highest among patients wearing thigh-length SCDs and TEDS. Problems with fit were 50% higher in those who wore thigh-length TEDS, and involved stockings that created restricting bands. Most patients understood the purpose of treatment, and older patients were more compliant than younger patients.

IMPLICATIONS FOR PRACTICE

Knee-length TEDS and SCDs are more comfortable for patients, encourage higher levels of compliance with treatment, do not pose a risk for venous stasis to patients by creating restricting bands, and are less expensive. Patients need ongoing education to resume wearing TEDS and SCDs after activities of daily living, and knee-length stockings and devices would be easier to reapply. The policy in our institution was changed for the use of knee-length compression stockings and SCDs.

Searching for circles of meaning and using spiritual experiences to help parents of infants with life-threatening illness cope

One of the major challenges parents can face is learning that their child has a life-threatening illness. A phenomenological study was completed to identify which interactions with health care providers were and were not helpful. Parents discussed what it was like to have an infant with a life-threatening illness and what helped them to cope. Parents indicated that they benefited from identifying "circles of meaning," or ways in which their infant touched another life. Parents appreciated hearing from health care providers that they felt close to their infant. This sense of connection allowed parents to reconstruct a semblance of meaning in the midst of a life-altering event. Parents were also influenced by intuitive and spiritual experiences associated with their infant's illness. Parents should be encouraged to reflect on spiritual moments and to identify how their critically ill infant influenced the lives of other family members, friends, and health care professionals.

Freshman seminars. Do they help pre-nursing students adjust to college life?

One purpose of this phenomenological study was to identify challenges pre-nursing students face as they enter college. A second purpose was to evaluate the effectiveness of a Freshman seminar in helping students develop a sense of belonging on campus. An interpretive analysis was completed of 20 student essays focused on these challenges and the effectiveness of the Freshman seminar. Students reported that three major challenges confronted them as they transitioned from high school to college. These challenges were to "make the space on campus my own," "get used to the way things are done in college," and "get a sense of who I really am." The Freshman seminar helped pre-nursing students settle into a new environment and better prepare themselves for nursing school. Strategies used in the freshman seminar are also applicable to service delivery settings.

Using Poetry to Discover and Share Significant Meanings in Child and Adolescent Mental Health Nursing

TOPIC

Does writing and reading poetry help nurse-therapists, students, and clients reflect on significant meanings and gain a greater understanding of intense clinical situations?

PURPOSE

To describe the use of poetry in managing intense feelings, discuss the relevant literature, articulate how students and clients responded to the use of poetry, and address the limitations of such an approach.

SOURCES

Published literature, clinical expertise, and poems written by the author.

CONCLUSIONS

Writing and reading poetry helps clinicians, students, and clients give voice to situations that touch their hearts. Poetry and literature should be used more extensively in clinical and educational settings.

Video-cued narrative reflection: a research approach for articulating tacit, relational, and embodied understandings

The author's purpose in this article is to describe the effectiveness of video-cued narrative reflection as a research approach for accessing relational, practice-based, and lived understandings. Video-cued narrative reflection provides moment-by-moment access to tacit experience. The immediate nature of the videotape captures emotional nuances, embodied perceptions, spatial influences, relational understandings, situational factors, and temporal manifestations. By watching videotaped interactions, participants are able to re-collect, re-experience, and interpret their life world. Video-cued narrative reflection allows participants to be simultaneously engaged and reflective while describing significant understandings. By inserting audiotaped reflective commentary of participants into the original videotape transcript, contextual meanings can be located and articulated more easily. Although not appropriate for all types of research, this approach offers promise for certain studies.

Gaps in service in the recognition and treatment of depression and suicidal ideation within a four-county area

PURPOSE

To examine gaps in service in the treatment of depression and suicidal ideation.

METHODS

A phenomenological investigation of clients' (n = 10) and service providers' (n = 40) perspectives.

FINDINGS

Compartmentalized systems of care and lack of continuity between inpatient and outpatient treatment contributed to a sense of frustration in both groups. Receiving mental health care was likened to being given a broken-apart puzzle with individual pieces shuffling around in a box. Little bits of help are available, but none of them mesh.

CONCLUSIONS

Comprehensive solutions are needed if the human and social implications of depression are to be addressed.

Nurture: the fundamental significance of relationship as a paradigm for mental health nursing

TOPIC

Whether nature or nurture is the most appropriate paradigm for mental health nursing practice, education, and research.

PURPOSE

To present detailed information that nurture is the most inclusive and sustaining paradigm for mental health nursing.

SOURCES

Published literature.

CONCLUSIONS

Psychological, social, cultural, environmental, biological, and experience-based problems are the root of mental illness. Mental health nursing must have a comprehensive paradigm that honors the relational nature of the nurse-patient relationship, the critical influence of environment, the importance of biological factors, and the way that narrative understanding and history shape behavior.

Integrating aesthetics into advanced practice mental health nursing: commercial film as a suggested modality

The purpose of this study was to explore the advantages and disadvantages of using feature films in teaching advanced practice mental health nursing. A phenomenological investigation was conducted of 11 master's student perspectives regarding the use of movies in an on-line course. According to the students, the disadvantages of movies were that films are time consuming to watch and often more dramatic than real-life situations. The advantages of using movies were that films are effective in promoting reflection and enhancing empathy. Students noted that movies poignantly portray emotional issues and are engaging in addition to being a good way both to present educational content and introduce ethical dilemmas. Using movies also may be effective with select clients as a once-removed way to introduce therapeutic discussions in outpatient practice.

Attending to embodied responses: a way to identify practice-based and human meanings associated with secondary trauma

Most researchers of secondary trauma have focused on the pathological aspects of embodied responses rather than their usefulness in interpreting clinical situations. In this study, the authors completed a phenomenological investigation of nursing and social work faculty and student experiences with secondary trauma. They focused on how physical sensations and perceptions alert clinicians to reflect on human meanings associated with traumatic events. Findings indicated that participants experienced strong physical sensations that served as a Geiger counter of meaning and helped clinicians reflect on and understand the traumatic event. Clinicians, educators, and students should take the time to reflect on physical sensations in order to fully understand the human and professional meanings embedded in these responses.

Intensity and challenge as an aspect of work satisfaction in an urban emergency room

This phenomenological study examined the lived experience of expert emergency room nurses in order to describe their sources of work satisfaction. An interpretive analysis was completed of interviews with 13 nurses in addition to observations of their practice. Experienced nurses described appreciating the challenge of working with complex patients, valuing the unpredictable nature of their work, and enjoying the intensity and fast pace of the emergency room as it helped them to focus. Because this appreciation for intensity and challenge was also an aspect of the nurses' personal lives, nurse managers should consider to what extent the personality characteristics of nurses interviewing for new positions match the unit culture. Scheduling interviews on the unit itself may facilitate nurses obtaining a reality-based understanding of the unit culture prior to beginning employment.

Client and provider perspectives regarding the stigma of and nonstigmatizing interventions for depression

Fifty clients and providers narrated their experiences with the stigma associated with seeking care for depression and/or suicidal ideation. Participants also shared their perspectives on ways to minimize stigma. The narrative interviews were audiotaped, transcribed into text, and then interpreted using an interpretive phenomenological method. Open communication; community awareness, education, and prevention; as well as community-centered and in-home services were identified as ways to minimize stigma and enhance the care available to depressed or suicidal individuals. The importance of modifying health care providers' attitudes and changing the climate of inpatient services were also highlighted as priorities by the participants.

Being with feelings as a recognition practice: developing clients' self-understanding

TOPIC

How are shifts in clients' self-understanding related to focusing on feelings during therapy sessions?

METHODS

A phenomenological study involving matched-pairs of clients and nurse-therapists using video-cued narrative reflection.

FINDINGS

Feelings disclose significance within a therapy session. Dialogical relationships and involvements help clients experience the feelings they are discussing, obtain feedback from therapists, and develop self-understanding.

CONCLUSIONS

Nurse educators should stress the importance of focusing on feelings in a session, and clinicians should practice this skill to facilitate a client's developing self-understanding.

Developing student evaluation instruments to measure instructor effectiveness

The authors detail the process of developing four specific tools for student evaluation of faculty performance at the master's and baccalaureate levels. To accomplish the desired goal of improving instruction, these authors believe student evaluation tools should be tailor-made to the educational setting and mode of delivery. The tools described in this article were developed to evaluate faculty performance in clinical-direct, on-campus laboratory, clinically precepted, and didactic settings.