Although the two important processes have many shared methods, they also have distinct features that need to be made explicit, especially when sharing findings in a public arena. Let nurses take the lead in forthright reporting of findings, by clearly identifying their origins and making recommendations for future investigations--both in research and organizational improvement projects.
This study was originally planned from September tenth through twelfth to assess concurrent use of three real-time data sources during a usual day. When the World Trade Center towers collapsed, the plan expanded to describe 24-hour blood pressure and heart rate, natural environment word use, television viewing/radio listening, and self-reported diary feelings for six undergraduate students in the midst of stressful upheaval. Heart rate, "we" word-use and television viewing/radio listening increased over time. Higher negative and lower positive feelings/emotions occurred during morning hours on September 11. Students connected with others and shared good thoughts. Measurement with real-time data sources was informative.
Nurses must learn about research and nonresearch sources of evidence and use this evidence to make patient care decisions. Nonresearch sources of evidence need to be studied for their contribution to evidence-based practice. Our patients expect that we will base our practice on the best evidence available. If we do not, we run the risk of delivering care that is ineffective.
The purpose of this study was to determine the effects of 16-week Kouk-Sun-Do (KSD) exercise on physical fitness, emotional state, and immunoglobulin A (IgA) in community-dwelling elders in Korea. A total of 19 elders in the intervention group and 20 elders in the control group participated. The KSD exercise with low-intensity exercise was performed over a 45-minute session, three times a week for a 16-week period. The results show the effectiveness of KSD exercise on the physical fitness, emotional state, and IgA, and KSD can be identified as a feasible type of low-intensity exercise for elders. The findings suggest the need to determine clinical significance of KSD for patients in specific clinical settings; nurses with training in KSD can play a key role in implementing movement-based nursing interventions for specific health outcomes.
This study examined the incidence of chest pain and cocaine use in 18 to 40 year olds who were seen in a public inner city emergency department. The medical records of a convenience sample of 386 subjects were reviewed during a 6 month period. Results revealed a significant differences in physiological, diagnostic, and patient history data associated with chest pain and cocaine use. These data that highlight the clinical features of cocaine users can be used as a profile for the management of cocaine-related cardiovascular problems.
The AONE poster sessions present some of the best and most innovative nursing leadership-driven projects in practice today. The opportunity for nurse leaders to present their work in a national forum is an honor for the individual nurse. To be recognized for the outstanding work that is going on each and every day in the nation's hospitals, healthcare systems, educational programs, and communities is a credit to the entire profession. At this time of public attention to the problematic side of the profession and the healthcare system, these innovative nursing leadership projects are indeed worthy of note.
The purpose of this study was to examine the 24-hour sleep/wake patterns of healthy elderly persons. Data was obtained from 14 elderly subjects who wore a wrist actigraph for 48 hours and completed an activity diary during the monitoring period. Although subjects spent slightly more than 7.5 hours in bed at night, they were asleep for just over 6 hours. Subjects did not have trouble falling asleep, but once asleep, had trouble remaining asleep. All subjects took one or more naps during the recording period, but daytime naps composed only a small fraction of their total sleep time. Total duration of daytime sleep averaged 59.8 minutes.
Anorexia nervosa is a chronic, life-threatening illness affecting adolescents with increasing incidence. Previous research has demonstrated that, although weight gain is a key to medical stabilization, there is wide and significant variability in treatment practices. Meal supervision in hospitalized patients involves the use of clinical staff as active and supportive observers during meal time. No studies to date have examined the effects of meal supervision in medically hospitalized patients with anorexia nervosa. The primary aim of this study was to examine the effect of meal supervision on outcomes during inpatient medical hospitalization.
A retrospective record review of 52 patients with restrictive eating disorders admitted to a tertiary pediatric hospital from July 2008 to July 2009 was conducted.
The data revealed higher average weights and improved overnight heart rate trends for patients who received at least 1 supervised meal during hospitalization compared with those who received no supervised meals.
The findings warrant further investigation of meal supervision as a possible treatment modality.
Older adults continue to experience problems with their medications, such as adverse drug events, incorrect use of prescription medications, and nonadherence to drug therapy. Using the qualitative approach of naturalistic inquiry, 27 community-dwelling adults over age 74 were interviewed and encouraged to describe situations or variables that help or hinder in their cardiovascular medication management processes. Helpful strategies included simplification, use of visual and tactile cues, and development of a medication routine. Hindering situations included decreased mental or sensory alertness, getting out of the routine, and not feeling well. Nurses can devise assessment and interventional methodologies from the themes described.
Patients who undergo abdominal surgery experience a phenomenon commonly called postoperative ileus (POI). Standard of care requires patients to get out of bed, sit in a chair, and begin ambulating the first postoperative day. No evidence supports standard care activities reduce POI duration. Rocking-chair motion has shown promise in reducing POI duration. Sixty-six participants were randomized into 2 groups. The experimental group (n = 34) received standard care plus the rocking-chair intervention; the control group (n = 32) received standard care. Participants in the experimental group had shorter duration of POI, no effect on medication use, and time to discharge.
Tap water and soapsuds are common enema solutions, but little is known about their effectiveness. Consequently, nurses have no guidance when choosing the best enema for a given patient. In this study, liver transplant patients were given either a tap water or soapsuds enema preoperatively. Amount of enema instilled into the colon and output were measured. Soapsuds enemas produced significantly greater output than tap water and were equally well tolerated. Most subjects who received tap water enemas retained more fluid than was eliminated. Based on these findings, nurses should use caution when giving repeated enemas to patients sensitive to large fluid loads.
AIM: The aim of this study was to examine whether caffeine abstinence in the evening could improve the sleep quality of those who habitually consume coffee. DESIGN: A double-blind control group design (caffeine and caffeine-free groups). SETTING: A university. SUBJECTS: A convenience sampling of 10 students (mean age 21.4years). METHODS: It was a 14-day experiment. For the first 7days, all participants consumed caffeinated coffee. In the following 7days, subjects consumed caffeinated or decaffeinated coffee according to their assigned group. MEASURES: Sleep-wake parameters, self-reported sleep quality and level of refreshment. RESULTS: There were no significant differences (p>.05) among the data of the two groups identified. No significant changes (p>.05) were found in the sleep quality of either group during the study. CONCLUSION: This study confirms that caffeine abstinence in the evening might not be helpful in sleep promotion. It highlights the need to implement evidence-based practice in health promotion.
The processes and procedures used to promote interrater reliability in the abstraction of data from medical records are described. Several proactive strategies that serve the purpose of leading to standard interpretations of clinical data are discussed. These include (a) establishment of priorities for the sources of information; (b) creation of orders of value for the likeliness of validity of recorded data; (c) standardization of terminology; and (d) reaffirmation of decisions, based on an evolving body of evidence. Lessons learned from this project can assist nurse researchers to develop high-quality information retrieval methods, when multiple observers (or abstractors) are used during a medical record abstraction data collection process.
Pain management science results are derived from research conducted using medical record.
This article describes methodological issues arising from abstracting pain management documentation (PMD) from the electronic medical record in three hospitals. After approval, PMD data were collected from the patient's history and physical, discharge summary, operative care notes, computerized nursing flow sheets, progress notes, and medication records.
Each acute care facility required a different approach to abstract data. Inconsistent documentation in pain management assessments, interventions, and reassessments were identified across hospitals.
Inconsistencies pose measurement threats and hinder benchmarking efforts. Work to standardize PMD across propriety computer systems is warranted.
The preparation of a strong, convincing abstract is a necessary professional skill and prized art form for nurse scientists and clinical scholars. The power and the role of an abstract are often overlooked. Abstracts are used in a variety of scholarly forums including articles submitted for publication, research proposals, and responses to "calls for abstracts" for presentations at scientific conferences. The purpose of this article is to emphasize the highlights of the "art" rather than the "cookbook" details associated with preparing an abstract. Each of the critical stages of abstract development is explored-planning, drafting, reviewing, peer reviewing, editing, and packaging. Likewise, a few, hopefully helpful, hints on developing the six key elements-background, purpose, sample, methods, results, and implications-of the scientific abstract are given. Polishing, the essential skill of preparing an abstract, takes time and persistence and will pay off in the long run. The well-crafted abstract is an initial step in the process of getting research and scholarly pursuits noticed and accepted.
N 1993, the National Runaway Hotline reported an estimated 1.5 million runaways and throwaways in the United States, and the U.S. Department of Justice reported an estimate of 577,800 runaways and throwaways (Finklehor, Hotaling, & Sedlak, 1990). They commonly live on the street, or stay with friends and relatives (Council on Scientific Affairs, 1989). Because many of the adolescents are not in contact with service agencies or shelters, estimates of the number of runaway, throwaway, and homeless adolescents vary widely. The larger estimate of 1.5 million runaways and throwaways attempts to consider the adolescents who are not in contact with service agencies or shelters. Issues of money, legal status as a minor, parental or guardian permission, unstable living conditions, and confidentiality often conflict with the need for services and shelter. Although estimates of the number of homeless, runaway, and throwaway youths in the United States vary, there is agreement on the definition of terms. A runaway has been away from home at
Theoretical and research-based clinical psychiatric nursing interventions are prerequisites for the advancement of the psychiatric mental health nursing practice (Babich & Voit, 1991). Based on these prerequisites, the authors implemented a group psychotherapy intervention for battered women using Campbell's adaptation (1986) of Litton's survivor-group prototype (1976). This group prototype was chosen because it specifically recognizes the strengths of survivors of violent experiences. Major process and content themes were identified through analysis of group psychotherapy sessions, substantiating the efficacy of this group prototype as a basis for intervention with woman abuse.
This article reports the results of an investigation of nurses' stereotypes of child abusers. Ninety-four registered nurses completed a questionnaire that measured subjects' knowledge of child abuse; professional contact with perpetrators and victims of abuse; knowledge of the causes of child abuse; and child abuser stereotypes. Results reveal a consensus among the subjects as to the stereotypes associated with child abusers. This study supports the notion that nurses stereotype individuals on the basis of demographic characteristics. This study also raises questions regarding the bias that may result from the use of child abuser stereotypes. Clinical decision-making processes could become compromised if biased judgements are used in planning nursing care for clients diagnosed as child abusers.
The purpose of this study was to gain insight into how nurses recover medical errors in the emergency department (ED) setting.
The research method was of exploratory descriptive design with qualitative analysis. Subjects who signed the informed consent participated in one of four focus groups centering on nurse's role in recovering errors. Questions were asked during the focus groups to elicit information regarding nurse's role in the three phases of error recovery, namely, identifying, interrupting, and correcting the error.
Five themes emerged to describe methods used by nurses to identify errors in the ED setting. These themes included: surveillance, anticipation, double checking, awareness of the "big picture," and experiential "knowing." Five themes emerged as methods used to interrupt errors: patient advocacy, offer of assistance, clarification, verbal interruption, and creation of delay. The themes for correcting an error were assembling the team and involving leadership.
The results of this study provide preliminary evidence of the strategies used by ED nurses in the recovery of medical error. Further research is needed to generalize these findings to other ED settings. Knowledge of effective recovery strategies can ultimately be used to develop interventions for reducing medical error and improving patient safety.
The purpose of this study was to examine selected health and cost outcomes of clients who used an academic nursing clinic (ANC) located in a high-rise public housing facility for low-income citizens. Service use, health promotion and screening, quality of care, satisfaction and costs were examined. Health outcomes were improved. Estimated cost savings were about $36,000 during the first year with reduced paramedic and police calls, hospitalizations, and emergency room visits. Findings show that advanced practice nurses can positively influence health outcomes by providing cost-effective quality health care.
Current guidelines in place for sleep and physical activity in childhood are the result of data collected in the form of self-reports. Exact measurement of activity dimensions and sleep characteristics are essential. The purpose of clearly established parameters is for the intent of verifying health outcomes and evaluating interventions. The purpose of this research was to determine the relationships between the objective dimensions of physical activity, sleep, weight status, academic achievement, and academic behavior. This cross-sectional correlational descriptive design examined the activity and sleep patterns continuously for 24hours/7days with triaxial accelerometers in a low income African American sample of 8-year-olds. A qualitative component gathered additional identifiers. This sample was overweight/obese, inactive, and sleep-deprived. Moderate-vigorous activity was correlated with reading scores. Confirmed in this research was the association between sleep duration, physical activity intensities, and academics. Positive health outcomes in children are endorsed by an energy balance.
Nurses conducting clinical research often test the feasibility and acceptability of interventions before using them in large-scale experimental studies. This article specifically reviews stepping exercise as an intervention with women. In a literature review, three stepping modes (steptreadmill, bench/step, and stepper) were compared, with the steptreadmill being identified as the most advantageous for use in experimental research. An exemplar was constructed to illustrate feasibility and acceptability of steptreadmill exercise (motorized stair climbing) in 11 women with hypertension. Steptreadmill exercise is feasible and acceptable and shows promise for use in experimental studies where strict control over the exercise performed is required.
The performance of the Acceptability E-scale was tested in a sample of 627 adult and older adult patients from various oncology clinics who completed an electronic symptoms survey. The revised Acceptability E-scale has strong psychometric properties and can be useful in assessing the acceptability and usability of computerized health-related programs in oncology and other health population.
Behavioral disturbances are common in elderly individuals, particularly in those suffering from dementia. Nurses are called on to manage these problem behaviors both in the nursing home and through home health care. There has been growing interest in nonpharmacological interventions for these problems, most notably behavioral therapies. However, until recently, no information was available regarding the acceptance by health care professionals on the use of these treatments with elderly individuals. The purpose of this study was to assess geriatric nurses' acceptance of two behavioral treatments (differential reinforcement of incompatible behavior and time-out from positive reinforcement) and the most commonly used treatment at this time, pharmacotherapy. Nurses were asked to read a clinical case vignette and three treatment descriptions, rating the treatments with Kazdin's Treatment Evaluation Inventory. Results show that both behavioral treatments, including a mildly aversive treatment (time-out) were rated more positively than pharmacotherapy. Nurses modified their ratings in response to described differences in the patient's cognitive functioning and place of residence. Most interesting, acceptability ratings were influenced by characteristics of nurse raters, including the nurses' educational background and the amount of contact with geriatric patients.
Gaining research access to adolescents and young adults is not straightforward and involves layers of negotiation and administration. Experiences of accessing adolescents and young adults aged 13-21 years are described in this article. Issues raised for consideration are: identifying clinical gatekeepers; seeking ethical approval; making direct contact with adolescents and young adults (hereafter referred to as young people); and dealing with parents as gatekeepers. Refusal rates, participation rates, and reasons are also considered. The issues raised provide practical insights that may be helpful to other researchers aiming to access adolescents and young adults.
The successful completion of a research grant requires accurate and timely implementation of the scientific research plan. Given the multiple demands of a research project, principal investigators (PIs) must rely on grant staff to perform many activities. To ensure that staff members have the knowledge and skills to perform these activities in accordance with the research plan, staff development is needed. Although numerous resources address staff development in nonresearch settings (e.g., Abruzzese, 1992;American Nurses' Association, 1990;McGregor, 1990;Orth, Wilkinson, & Benfari, 1990;Phelps, 1990;Weiss, 1989), little information is available to address the special staff development needs in a research project. This article addresses these needs.Specifically, this article provides PIs with practical guidance for determining staffing needs and selecting staff for a research project. Additionally, it provides guidance for using staff development to enhance the research skills of the staff so they can assist in completing the grant activities and can grow into more seasoned researchers themselves. Particular attention is focused on providing development experiences that will enable the staff to assist the PI in the following activities: supervising personnel; fostering positive public relations; handling routine office tasks; producing correspondence and reports; maintaining confidentiality; managing the budget; developing and testing data collection instruments; collecting, entering, monitoring, and analyzing data; keeping abreast of current research; disseminating findings; and laying the groundwork for future research.
The challenges and barriers associated with recruiting a representative sample of community-residing older adult caregivers for persons with Alzheimer's disease (AD) may limit efficient accrual in a reasonable period. These limitations may inhibit study completion, result in underpowered samples, or overextend research budgets. With the use of both grassroots recruiting and local community resources, successful recruitment methods and experiences obtained during two studies, the first in older adults caring for a spouse with AD and the second in family caregivers for African Americans with AD, are described. Strategies used to accrue the samples are discussed within the framework of knowledge, planning, and creativity.
Bacterial vaginosis (BV), often asymptomatic, is associated with increased gynecologic, obstetric, and neonatal risks. This pilot study examined the use of a nurse researcher-developed home self-test system comprised of three components-education, self-test kit application, and a scoring method-with a volunteer sample of 33 nonpregnant, childbearing-age women. The women accurately self-tested for BV using the system and sought definitive professional diagnosis and treatment. The next phase of research would be with pregnant women at risk for preterm labor and delivery to determine use of the system in an effort to reduce maternal and fetal complications.
Even though nurses assess volume output for blood, emesis, and stool using visual processing, assessment accuracy has not been studied nor has the application of information-processing theory to visual assessment been shown. The purpose of this investigation was to determine the application of information-processing theory to accuracy in visual assessment of emesis. Nursing students and practicing pediatric nurses (N=109) participated in this nonexperimental study in which 20 randomly selected volumes were presented as visual displays of formula on receiving blankets. Subjects were asked to determine the volume. Findings showed that few displays were assessed accurately (M=2.63), but that subjects who have been taught to use a mental frame of reference in assessment were significantly more accurate. Error increased with the display volume. Additional analysis showed that subject practice role, nature of clinical practice, and number of displays assessed for weight accounted for significant proportions of variance in relative error. These findings are consistent with information-processing theory and suggest that nurses who are doing visual assessment should learn a processing method that presents a mental frame of reference with which they compare the observed volume. Further, perceived weight of the object observed should be added to visual processing to increase accuracy.
This study examines how the framing of educational information affects changes in health-related knowledge, attitudes, and behavior. Patients with diabetes viewed either a gain- or a loss-framed informational video about proper foot care and its importance for the prevention of health-threatening problems. The gain-framed messages sustained long-term positive behavioral change. Regression analyses showed that changes in attitudes were predicted by changes in knowledge and that both framing and attitudes were predictors of long-term behavior. This study is important for nurses and certified diabetes educators in that it demonstrates that gain-framed messages are effective in sustaining health-promoting behavior.
Omega-3 (Omega-3) and omega-6 (Omega-6) fatty acids (FAs) are essential FAs needed for brain and retina development and maintenance of red blood cell (RBC) membranes. This study investigated the association between the profile of FAs in the membranes of RBCs and malnutrition in children. Demographic, anthropometric, and breast-feeding data and blood samples for analysis of FAs were obtained from malnourished and well-nourished children. The results indicate significant between-group differences in the profile of FAs. These findings support the need for adequate intake of Omega-3 FAs in promoting optimal growth and development processes and emphasize the role of nurses as providers of nutritional and anticipatory guidance for parents and caretakers.
Experienced obstetric nurse and midwives indicate they can differentiate among sounds indicating that a woman is (a) beginning to manifest the effort to bear down, (b) experiencing pain, or (c) frightened. This study examined the acoustical properties of work/effort, childlike, and out-of-control utterances to determine whether their acoustical properties differed. Out-of-control utterances are more tense but contain similar levels of shimmer and pitch as childlike utterances. Work/effort utterances are higher pitched and more tense than childlike utterances. Work/effort utterances contain more shimmer but have similar levels of pitch and tenseness as out-of-control utterances.
The purpose of this study was to identify nurse caring behaviors desired by patients with acquired immunodeficiency syndrome (AIDS) or human immunodeficiency virus (HIV) seropositive. Forty-six adults with either a diagnosis of AIDS or HIV-seropositive participated in the study. Subjects indicated "treat me as an individual" as the highest scoring item. Themes derived from the data included acceptance, respect, treatment of the person as an individual, and nonjudgmental attitudes of the nurse toward the person with AIDS/HIV.