ISRN Nursing The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. “Negotiating, Navigating, and Networking”: Three Strategies Used by Nursing Leaders to Shape the Adoption and Incorporation of Simulation into Nursing Curricula—A Grounded Theory Study Tue, 08 Apr 2014 09:59:01 +0000 Background. Implementing simulation requires a substantial commitment of human and financial resources. Despite this, little is known about the strategies used by academic nursing leaders to facilitate the implementation of a simulation program in nursing curricula. Methods. A constructivist grounded theory study was conducted within 13 nursing programs in Ontario, Canada. Perspectives of key stakeholders including nursing administrators , simulation leaders , and nursing faculty were analyzed using the constant comparison method. Results. Nursing leaders, specifically nursing administrators and simulation leaders who successfully led the adoption and incorporation of simulation into nursing curricula, worked together and utilized negotiating, navigating, and networking strategies that impacted the adoption and incorporation of simulation into nursing curricula. Conclusions. Strategies that were found to be useful when planning and executing the adoption and incorporation of an innovation, specifically simulation, into nursing curricula provide practical approaches that may be helpful to nurse leaders when embarking upon an organizational change. Karyn Taplay, Susan M. Jack, Pamela Baxter, Kevin Eva, and Lynn Martin Copyright © 2014 Karyn Taplay et al. All rights reserved. The Efficacy of Optimism: Benefit Finding in the Treatment of Diabetes in Iranian Patients Tue, 18 Mar 2014 00:00:00 +0000 The incidence of diabetes mellitus is on the rise around the world. Middle Eastern countries will be facing a vast increase in the number of diabetes mellitus cases by 2030. Diagnosis of a chronic disease such as diabetes mellitus can be a shocking and life-altering event. Conversely, a diagnosis of a chronic illness can also offer the patient opportunities to change unhealthy behaviors such as poor diet, smoking, and lack of exercise, making them healthier than before their diagnosis. This is referred to as “benefit finding”. This study reveals the many benefit findings of Iranian patients who have been diagnosed with diabetes mellitus and illustrates how benefit finding can be an integral part of long-term patient care. Hossein Karimi Moonaghi, Hossein Namdar Areshtanab, and Leila Jouybari Copyright © 2014 Hossein Karimi Moonaghi et al. All rights reserved. Job Burnout, Mood State, and Cardiovascular Variable Changes of Doctors and Nurses in a Children’s Hospital in China Sun, 09 Mar 2014 11:20:14 +0000 Aims. This study examines mood and cardiovascular variables related to job stress and burnout in hospital personnel. Main Methods. 400 nurses and physicians from a children’s hospital in China were recruited. Participants completed job stress, burnout, and mood state questionnaires. Cardiovascular variables such as body mass index (BMI), triglyceride (TG), and high density lipoprotein (HDL) were measured. Key Findings. Job stress and burnout were significantly associated with mood state. Statistically significant correlations were found between triglyceride levels and job stress scores (, ), BMI and job stress scores (, ), and HDL levels and job stress scores (, ). Significance. Mood state changes may be related to job stress and job burnout, in turn, associated with triglycerides and HDL levels. Public health implications and interventions are discussed. Shuchang He, Yan Chen, Junya Zhan, Johnna Wu, and Mark Opler Copyright © 2014 Shuchang He et al. All rights reserved. Challenges of Introducing Participant Observation to Community Health Research Wed, 15 Jan 2014 16:25:09 +0000 Participant observation elicits unique observation data from both an insider’s and an outsider’s perspectives. Despite the growing tendency to adopt participant observation strategies in health care research regarding health-related beliefs and types of behavior, the use of participant observation in current research is mostly limited to structured clinical settings rather than community settings. In this paper, we describe how we use participant observation in a community health research study with Chinese-born immigrant women. We document discrepancies between these women’s beliefs and types of behavior regarding health and health promotion. We further discuss the ethnical, time, and setting challenges in community health research using participant observation. Possible solutions are also discussed. Meng Zhao and Yingchun Ji Copyright © 2014 Meng Zhao and Yingchun Ji. All rights reserved. What Factors Facilitate Good Learning Experiences in Clinical Studies in Nursing: Bachelor Students’ Perceptions Tue, 17 Dec 2013 15:00:13 +0000 Clinical studies constitute 50% of the bachelor program in nursing education in Norway, and the quality of these studies may be decisive for the students’ opportunities to learn and develop their professional competences. The aim of this study was to explore what bachelor students’ in nursing perceived to be important for having good learning experiences in clinical studies. Data was collected in a focus group interview with eight nursing students who were in the last year of the educational program. The interview was transcribed verbatim, and qualitative content analysis was used for exploring and interpreting the content of the interview text. One main theme emerged from the analysis: “being in a vulnerable and exposed position characterized by conflicting needs.” Four categories were found: “aspects related to the clinical setting”, “aspects related to the nurse supervisor,” “aspects related to the student,” and “aspects related to the student-supervisor relationship”. The findings revealed that the students' learning experiences and motivation were related to individual, relational, and organizational aspects. The students highlighted their own as well as their supervisors' attitudes and competences and the importance of positive relationships. In addition, feeling welcomed, included, and valued in the ward improved their motivation, self-confidence, and self-respect. Bjørg Dale, Arne Leland, and Jan Gunnar Dale Copyright © 2013 Bjørg Dale et al. All rights reserved. Light Reduction Capabilities of Homemade and Commercial Incubator Covers in NICU Tue, 29 Oct 2013 10:44:52 +0000 Reduction of high-risk neonates’ exposure to aversive light stimulation is an important component of developmentally supportive care. In neonatal intensive care unit (NICU), usually light is reduced by reducing the room’s light level or by using incubator covers. Many types of incubator covers are in use, including homemade and commercial covers. A comparative study was used to determine the light reducing capabilities of 19 homemade incubator covers, 2 commercial covers, and 1 receiving blanket. The covers were tested by covering and uncovering an incubator and an oxygen hood in the NICU during daytime and nighttime lightings. The light reducing capabilities value was determined for each cover using an Extech light dosimeter when the cover was placed over and removed from an oxyhood, and an incubator. The study showed that the light reducing capability of the commercial covers was 91.2%, the homemade covers capability was 72.1%, and the receiving blankets capability was 55.1%. A significant difference between the commercial and homemade covers was found (, ). Commercial incubator covers are the most effective covers to achieve light reduction; homemade covers can be effective if made large enough so that they completely cover all sides of the incubator. Susan M. Ludington-Hoe and Amel Abouelfettoh Copyright © 2013 Susan M. Ludington-Hoe and Amel Abouelfettoh. All rights reserved. Reasons for Nonattendance across the Hepatitis C Disease Course Wed, 11 Sep 2013 15:30:50 +0000 This descriptive qualitative study examined the patient, provider, and institutional factors contributing to nonattendance for hepatitis C (HCV) care throughout the disease course. Eighty-four patients and health and social care providers were interviewed. Thematic analysis of the data yielded 6 interrelated nonattendance themes: self-protection, determining the benefits, competing priorities, knowledge gaps, access to services, and restrictive policies. Factors within the themes varied with the disease course, type of provider/service, and patient context. Nonattendance could span months to years and most frequently began at diagnosis where providers either advised that followup was not necessary or did not recommend any followup. The way services were organized (low barrier access) and delivered (nonjudgmental approach) and higher HCV knowledge levels of patients and providers encouraged attendance. This is the first study to explore the reasons for nonattendance for HCV care throughout the disease course and validate them from multiple perspectives. There are missed opportunities for providers to encourage attendance throughout the disease course beginning at diagnosis. Interventions required include development of integrated health and social service delivery models; mechanisms to improve knowledge dissemination of the disease, its management, and treatment; and implementation of standardized followup protocols for liver disease monitoring in primary care. Gail Butt, Liza McGuinness, Terri Buller-Taylor, and Sandi Mitchell Copyright © 2013 Gail Butt et al. All rights reserved. Study on Situational Influences Perceived in Nursing Discipline on Health Promotion: A Qualitative Study Mon, 02 Sep 2013 14:22:41 +0000 Introduction and Objectives. Nurses, as behavioral models, play a key role in health promotion, and their attitudes towards health promotion highly influence their health and performance. The aim of this study is to explore nursing students' perception of studies in nursing discipline as a situational influence on health promotion. Materials and Methods. This study was conducted using directed content analysis, by means of 20 deep semistructured interviews with nursing students. The participants were selected on purposive sampling. Data was analyzed by the qualitative content analysis method. All interviews were recorded, transcribed, and reviewed, and all codes were extracted and summarized. The codes were subcategorized on the basis of centralization and were categorized after review of subcategories, and finally, a theme was determined. Findings. The theme of nursing discipline's situational influence on nursing students' health promotion was revealed. This theme consisted of “choosing the field,” “unfavorable environmental factors,” “negative impacts of studies in nursing discipline on health,” “positive effects of studies in nursing discipline on health”, “needs,” “attractiveness (aesthetics),” and “coping with negative situational influences in nursing discipline.” Conclusion. The perception of studies in nursing discipline as a health-promoting behavior is under influence of social environment. Considering the importance of the students' positive perception of the existing situation, it is essential to pay attention to their attitudes and perceptions so that they can provide better services to patients. Meimanat Hosseini, Tahereh Ashk Torab, Mohammad Hossein Taghdisi, and Safar Ali Esmaeili Vardanjani Copyright © 2013 Meimanat Hosseini et al. All rights reserved. Young Registered Nurses' Intention to Leave the Profession and Professional Turnover in Early Career: A Qualitative Case Study Tue, 20 Aug 2013 08:16:42 +0000 In a time of global nursing shortages an alarming number of young registered nurses have expressed a willingness to leave the profession. In this qualitative case study we investigate in depth why young nurses leave nursing profession and reeducate themselves for a new career. The study is based on longitudinal interviews of three young registered nurses in Finland. These nurses were first interviewed between December 2006 and May 2007, when they were 29–32 years old and having an intention to leave the profession. The second interview took place four years later, from January 2011 to March 2011 when all of them had made the transition to a new career. Data were analyzed in two stages. In the first stage, comprehensive career story narratives were formed on the basis of the interviews. In the second stage, emerging themes in these stories were compared, contrasted, and interpreted in the context of the overall career histories. Nursing as a second career choice and demanding work content as well as poor practice environment and the inability to identify with the stereotypical images of nurses were main themes that emerged from these career stories. The results of this interpretative qualitative study reflect a shift toward insights into understanding professional turnover as a complex and long-lasting process. Mervi Flinkman, Ulpukka Isopahkala-Bouret, and Sanna Salanterä Copyright © 2013 Mervi Flinkman et al. All rights reserved. Implementation Interventions Used in Nursing Homes and Hospitals: A Descriptive, Comparative Study between Austria, Germany, and The Netherlands Sun, 14 Jul 2013 09:47:14 +0000 Translating guidelines into nursing practice remains a considerable challenge. Until now, little attention has been paid to which interventions are used in practice to implement guidelines on changing clinical nursing practice. This cross-sectional study determined the current ranges and rates of implementation-related interventions in Austria, Germany, and The Netherlands and explored possible differences between these countries. An online questionnaire based on the conceptual framework of implementation interventions (professional, organizational, financial, and regulatory) from the Cochrane Effective Practice and Organization of Care (EPOC) data collection checklist was used to gather data from nursing homes and hospitals. Provision of written materials is the most frequently used professional implementation intervention (85%), whereas changes in the patient record system rank foremost among organisational interventions (78%). Financial incentives for nurses are rarely used. More interventions were used in Austria and Germany than in The Netherlands (20.3/20.2/17.3). Professional interventions are used more frequently in Germany and financial interventions more frequently in The Netherlands. Implementation efforts focus mainly on professional and organisational interventions. Nurse managers and other responsible personnel should direct their focus to a broader array of implementation interventions using the four different categories of EPOC’s conceptual framework. Helga E. Breimaier, Ruud J. G. Halfens, Doris Wilborn, Esther Meesterberends, Gunnar Haase Nielsen, and Christa Lohrmann Copyright © 2013 Helga E. Breimaier et al. All rights reserved. A Comparative Analysis of Cultural Competence in Beginning and Graduating Nursing Students Thu, 23 May 2013 11:47:05 +0000 The ethnic proportions of the population in the United States are rapidly changing, with the nation’s minority population at approximately 101 million. This is also true for the West Texas region, where locally in a city with 183,000 residents, 43 different languages are spoken suggesting that cultural education needs to be included in nursing program curricula. Therefore, a study was conducted during a period of curriculum revision to determine if the current nursing curriculum at a public university offers enough education and experience for graduating nurses to care for such a diverse population by comparing their perceptions of cultural competence with beginning sophomore nursing students' perceptions. Participants were asked to complete the Cultural Competence Assessment (CCA) tool in order to evaluate perceptions of cultural competence. Upon analysis of the data, perceptions of cultural competence among graduating nursing students were significantly higher () than the perceptions of cultural competence among beginning nursing students. These results support that nursing students perceive that they have become culturally competent during their nursing education, leading to implications of the need for continued education relating to this concept, beginning with the first course and continuing throughout the nursing curriculum. Helen Reyes, Lance Hadley, and Deborah Davenport Copyright © 2013 Helen Reyes et al. All rights reserved. An Analysis of Canadian Psychiatric Mental Health Nursing through the Junctures of History, Gender, Nursing Education, and Quality of Work Life in Ontario, Manitoba, Alberta, and Saskatchewan Sun, 28 Apr 2013 15:57:43 +0000 A society that values mental health and helps people live enjoyable and meaningful lives is a clear aspiration echoed throughout our Canadian health care system. The Mental Health Commission of Canada has put forth a framework for a mental health strategy with goals that reflect the virtue of optimal mental health for all Canadians (Mental Health Commission Canada, 2009). Canadian nurses, the largest group of health care workers, have a vital role in achieving these goals. In Canada, two-thirds of those who experience mental health problems do not receive mental health services (Statistics Canada, 2003). Through a gendered, critical, and sociological perspective the goal of this paper is to further understand how the past has shaped the present state of psychiatric mental health nursing (PMHN). This integrative literature review offers a depiction of Canadian PMHN in light of the intersections of history, gender, education, and quality of nursing work life. Fourteen articles were selected, which provide a partial reflection of contemporary Canadian PMHN. Findings include the association between gender and professional status, inconsistencies in psychiatric nursing education, and the limitations for Canadian nurse practitioners to advance the role of the psychiatric mental health nurse practitioner. Mary Smith and Nazilla Khanlou Copyright © 2013 Mary Smith and Nazilla Khanlou. All rights reserved. The Factors Affecting the Refusal of Reporting on Medication Errors from the Nurses' Viewpoints: A Case Study in a Hospital in Iran Tue, 09 Apr 2013 16:32:48 +0000 Objective. Medication errors are the most common types of medical errors which considerably endanger the patient safety. This survey aimed to study the factors influencing not reporting on medication errors from the nurses’ viewpoints in Abbasi Hospital of Miandoab, Iran. Methods. This was a cross-sectional, descriptive and analytical study conducted in 2012 in which all nurses () working in different inpatient units were studied using a consensus method. Required data were collected using a questionnaire. Collected data were analyzed through some statistical tests including Independent -test, ANOVA, and chi-square. Results. According to the results, the most important reasons for not reporting on medication errors were related to the managerial factors (), factors related to the process of reporting (), and fear of the consequences of reporting (), respectively. Also, there was a significant relationship between employment status and fear of the Consequences of reporting on medication errors (). Conclusion. This study results showed that managerial factors had the greatest role in the refusal of reporting on medication errors. Therefore, for example, establishing a mechanism to improve quality rather than focus only on finding the culprits and blaming them can result in improving the patient safety. Mohammadkarim Bahadori, Ramin Ravangard, Amin Aghili, Jamil Sadeghifar, Mahdi Gharsi Manshadi, and Javad Smaeilnejad Copyright © 2013 Mohammadkarim Bahadori et al. All rights reserved. Nurse Managers' Perceptions Related to Their Leadership Styles, Knowledge, and Skills in These Areas—A Viewpoint: Case of Health Centre Wards in Finland Wed, 03 Apr 2013 09:17:42 +0000 The purpose of this study was to explore nurse managers’ perceptions related to their leadership styles, knowledge, and their skills in these areas in health centre wards in Finland. The data were collected from nurse managers () in health centre hospitals in Finland using a structured questionnaire (response rate 63%). Six leadership styles—visionary, coaching, affiliate, democratic, commanding, and isolating—were reflected on. Almost all respondents in every age group considered four leadership styles—visionary, coaching, affiliate, and democratic—to be very important or important. Nurse managers estimated their knowledge and skills in leadership styles to be essentially fairly sufficient or sufficient. Nurse managers’ abilities to reflect, understand, and, if necessary, change their leadership style influence the work unit’s success and employees’ job satisfaction. Nurse managers, especially new nurse managers, need more theoretic, evidence-based education to cope with these expectations and to develop their professional abilities. Together with universities, health care organizations should start planning nurse manager education programmes that focus on strategic issues, leadership, job satisfaction, challenging situations in leadership, change management, work unit management (e.g., economy, efficiency, and resources), and how the nurse managers consider their own wellbeing. Soili Vesterinen, Marjo Suhonen, Arja Isola, Leena Paasivaara, and Helena Laukkala Copyright © 2013 Soili Vesterinen et al. All rights reserved. The Value of Peer Learning in Undergraduate Nursing Education: A Systematic Review Wed, 03 Apr 2013 09:15:47 +0000 The study examined various methods of peer learning and their effectiveness in undergraduate nursing education. Using a specifically developed search strategy, healthcare databases were systematically searched for peer-reviewed articles, with studies involving peer learning and students in undergraduate general nursing courses (in both clinical and theoretical settings) being included. The studies were published in English between 2001 and 2010. Both study selection and quality analysis were undertaken independently by two researchers using published guidelines and data was thematically analyzed to answer the research questions. Eighteen studies comprising various research methods were included. The variety of terms used for peer learning and variations between study designs and assessment measures affected the reliability of the study. The outcome measures showing improvement in either an objective effect or subjective assessment were considered a positive result with sixteen studies demonstrating positive aspects to peer learning including increased confidence, competence, and a decrease in anxiety. We conclude that peer learning is a rapidly developing aspect of nursing education which has been shown to develop students’ skills in communication, critical thinking, and self-confidence. Peer learning was shown to be as effective as the conventional classroom lecture method in teaching undergraduate nursing students. Robyn Stone, Simon Cooper, and Robyn Cant Copyright © 2013 Robyn Stone et al. All rights reserved. A Statewide Case Management, Surveillance, and Outcome Evaluation System for Children with Special Health Care Needs Wed, 06 Mar 2013 16:07:13 +0000 Objectives. To evaluate the feasibility of implementing a statewide children with special health care needs (CSHCN) program evaluation, case management, and surveillance system using a standardized instrument and protocol that operationalized the United States Health and Human Services CSHCN National Performance Measures. Methods. Public health nurses in local public health agencies in Washington State jointly developed and implemented the standardized system. The instrument was the Omaha System. Descriptive statistics were used for the analysis of standardized data. Results. From the sample of CSHCN visit reports (), 314 problems and 853 interventions were documented. The most common problem identified was growth and development followed by health care supervision, communication with community resources, caretaking/parenting, income, neglect, and abuse. The most common intervention category was surveillance (60%), followed by case management (24%) and teaching, guidance, and counseling (16%). On average, there were 2.7 interventions per problem and 6.7 interventions per visit. Conclusions. This study demonstrates the feasibility of an approach for statewide CSHCN program evaluation, case management, and surveillance system. Knowledge, behavior, and status ratings suggest that there are critical unmet needs in the Washington State CSHCN population for six major problems. Karen A. Monsen, Scott A. Elsbernd, Linda Barnhart, Jacquie Stock, Carla E. Prock, Wendy S. Looman, and Maria Nardella Copyright © 2013 Karen A. Monsen et al. All rights reserved. Do High Frequency Ultrasound Images Support Clinical Skin Assessment? Thu, 21 Feb 2013 10:23:37 +0000 High frequency ultrasound imaging has been reported as a potential method of identifying the suspected tissue damage in patients “at risk” of pressure ulceration. The aim of this study was to explore whether ultrasound images supported the clinical skin assessment in an inpatient population through identification of subcutaneous tissue damage. Skin on the heels and/or sacral coccygeal area of fifty vascular surgery inpatients was assessed clinically by tissue viability nurses and with ultrasound pre operatively and at least every other day until discharge. Images were compared to routine clinical skin assessment outcomes. Qualitative classification of ultrasound images did not match outcomes yielded through the clinical skin assessment. Images corresponding to 16 participants were classified as subgroup 3 damage at the heels (equivalent to grade 2 pressure ulceration); clinical skin assessment rated no heels as greater than grade 1a (blanching erythema). Conversely, all images captured of the sacral coccygeal area were classified as normal; the clinical skin assessment rated two participants as grade 1b (non-blanching erythema). Ultrasound imaging is a potentially useful adjunct to the clinical skin assessment in providing information about the underlying tissue. However, further longitudinal clinical assessment is required to characterise images against actual and “staged” pressure ulceration. Alison P. Porter-Armstrong, Catherine Adams, Anne S. Moorhead, Jeannie Donnelly, Jane Nixon, Daniel L. Bader, Courtney Lyder, and May D. Stinson Copyright © 2013 Alison P. Porter-Armstrong et al. All rights reserved. Subjectively Evaluated Effects of Domestic Violence on Well-Being in Clinical Populations Tue, 05 Feb 2013 13:23:09 +0000 Effects of domestic violence are reflected in victims' physical, psychological, and sexual health as well as in victims' subjective evaluations of health or subjective well-being. The principal aim of this study was to study the extent to which the consequences of domestic violence are reflected in patients' subjectively evaluated well-being, life management, and sense of security in an emergency department, a maternity department, and a reception unit of a psychiatric hospital. A questionnaire on the effects of domestic violence was administered to 530 patients. 61 patients reported either current or previous domestic violence that affected their current well-being and life management. Domestic violence was reported to have an effect on subjective well-being and sense of security: the more recent or frequent the experience of violence was, the greater was considered its impact on well-being and sense of security. Routine inquiry can uncover hidden cases of abuse and hence would be of great benefit in the healthcare context. Early identification of abuse victims can prevent further harm caused by violence. Marika Poutiainen and Juha Holma Copyright © 2013 Marika Poutiainen and Juha Holma. All rights reserved. Prevention, Rehabilitation, and Mitigation Strategies of Cognitive Deficits in Aging with HIV: Implications for Practice and Research Sun, 03 Feb 2013 07:35:52 +0000 Highly active antiretroviral therapy has given the chance to those living with HIV to keep on living, allowing them the opportunity to age and perhaps age successfully. Yet, there are severe challenges to successful aging with HIV, one of which is cognitive deficits. Nearly half of those with HIV experience cognitive deficits that can interfere with everyday functioning, medical decision making, and quality of life. Given that cognitive deficits develop with more frequency and intensity with increasing age, concerns mount that as people age with HIV, they may experience more severe cognitive deficits. These concerns become especially germane given that by 2015, 50% of those with HIV will be 50 and older, and this older cohort of adults is expected to grow. As such, this paper focuses on the etiologies of such cognitive deficits within the context of cognitive reserve and neuroplasticity. From this, evidence-based and hypothetical prevention (i.e., cognitive prescriptions), rehabilitation (i.e., speed of processing training), and mitigation (i.e., spaced retrieval method) strategies are reviewed. Implications for nursing practice and research are posited. David E. Vance Copyright © 2013 David E. Vance. All rights reserved. Iranian Nurses’ Attitudes and Perception towards Patient Advocacy Sun, 30 Dec 2012 12:02:49 +0000 Patient advocacy is an inherent component of professional nursing ethics; in other words, nurses' enough knowledge would be essential to gain a positive attitude towards nursing advocacy. Using a descriptive-analytic design, this study aimed to assess the correlation between nurses' perception and attitudes towards patient advocacy, amongst 385 nurses in Kerman, Iran; hence, a three-part questionnaire was applied: part I, a demographic data sheet, part II, attitude measuring instrument, and part III, perception measuring instrument in nursing advocacy. The results implied that fairly positive attitudes and perception were found amongst the participants, and nurses’ attitudes, in general, were positively correlated to their perception toward nursing advocacy. This means that with an improvement in perception, the attitude would also improve. In addition to our findings, it seems that these nurses needed more advocacy educational programs and support from responsible employers. Mohadeseh Motamed-Jahromi, Abbas Abbaszadeh, Fariba Borhani, and Homa Zaher Copyright © 2012 Mohadeseh Motamed-Jahromi et al. All rights reserved. Cancer-Specific Stress and Mood Disturbance: Implications for Symptom Perception, Quality of Life, and Immune Response in Women Shortly after Diagnosis of Breast Cancer Thu, 20 Dec 2012 10:30:02 +0000 Purpose. To determine the levels of cancer-specific stress and mood disturbance in women shortly after diagnosis of breast cancer and to assess their associations with symptom perception, quality of life, and immune response. Design. Descriptive and correlational. Sample and Setting. One hundred women with newly diagnosed breast cancer were recruited from interdisciplinary breast clinics. Methods. Baseline data were collected using standardized questionnaires and established bioassay prior to the initiation of cancer adjuvant therapy. Blood samples were collected about the same time of day. Results. High cancer-specific stress was significantly correlated with high mood disturbance, which, in turn, was correlated with high symptom perception, poor quality of life, and an immune profile indicating high neutrophils and low lymphocytes. Conclusions. High cancer-specific stress and related mood disturbance show extensive negative relationships with multiple behavioral, clinical, and biological factors. Implications for Nursing. Routine screening for cancer-related stress and mood disturbance should be incorporated into nursing practice for all patients diagnosed with cancer. Given broad negative associations with other biobehavioral factors, early identification of patients at risk and provision and evaluation of stress and mood management programs may have a beneficial effect on subsequent health outcomes over time. Duck-Hee Kang, Na-Jin Park, and Traci McArdle Copyright © 2012 Duck-Hee Kang et al. All rights reserved. Gender, Work, and Health for Trans Health Providers: A Focus on Transmen Mon, 17 Dec 2012 14:37:33 +0000 Well-documented health research points to trans people’s vulnerability to health inequities that are linked to deeply embedded structural and social determinants of health. Gender and work, as social determinants of health for trans people, both shape and are shaped by multiple factors such as support networks, social environments, income and social status, shelter, and personal health practices. There is a gap in the nursing literature in regards to research on work and health for diverse trans people and a virtual silence on the particular issues of trans-identified health providers. This qualitative study used comparative life history methodology and purposeful sampling to examine links among work, career, and health for transmen who are health providers. Semistructured interviews were completed with four Canadian transmen involved in health care professional and/or practice contexts with diverse professions, age, work, and transitioning experiences. Critical gender analysis showed that unique and gender-related critical events and influences shape continuities and discontinuities in their careerlives. This strength-based approach foregrounds how resilience and growth emerged through participants’ articulation with everyday gender dynamics. These findings have implications for nursing research, education, and practice that include an understanding of how trans providers “do transgender work” and supporting them in that process. Judith A. MacDonnell and Alisa Grigorovich Copyright © 2012 Judith A. MacDonnell and Alisa Grigorovich. All rights reserved. Evaluation of Nurses’ Perceptions on Providing Patient Decision Support with Cardiopulmonary Resuscitation Wed, 05 Dec 2012 16:30:54 +0000 The decision whether to receive cardiopulmonary resuscitation (CPR) is a decision in which the personal values of the patient must be considered along with information about the risks and benefits of the treatment. A decision aid can be used to provide patient decision support to a patient who is seriously ill and needs to consider CPR options. The goal of this project was to identify the barriers and facilitators to using a CPR decision aid, through evaluating nursing perceptions on providing patient decision support. Using a needs assessment, it was determined that implementing a patient decision aid for CPR status in the Acute Monitor Area (AMA) of The Ottawa Hospital would be an excellent quality improvement project. The nurses who chose to participate were given an education session regarding patient decision support. Questionnaires were distributed to evaluate their views of patient decision support and decision aids before and after the education session and implementation of the CPR decision aid. Questionnaire results did not indicate a significant change between before or after education session and decision aid implementation. Qualitative reports did indicate that nurses generally have positive attitudes toward patient decision support and decision aids. The nurses identified specific barriers and facilitators in their commentaries. This clinically relevant data supports the idea that patient decision support should be integrated into daily nursing practice. Nicole Pyl and Prudy Menard Copyright © 2012 Nicole Pyl and Prudy Menard. All rights reserved. Health Is Belonging: Lived Experiences during Recovery after Pancreaticoduodenectomy Wed, 05 Dec 2012 13:23:43 +0000 The aim of this study was to explore the lived experience of the symptoms, health, and illness reported by patients recovering after pancreaticoduodenectomy ad modum Whipple due to pancreatic or periampullary cancer. Thirteen patients with pancreatic or periampullary cancer who underwent pancreaticoduodenectomy ad modum Whipple between 2006 and 2008 were interviewed during postoperative recovery. Data were analysed using the phenomenological-hermeneutic method. The structural analysis of patient experiences revealed that recovery after pancreaticoduodenectomy was described as recapturing everyday life, being healthy, and looking to the future. Participants experienced symptoms but did not dwell on them, instead they stated that their general health was good. They strived to regain their former precancer selves and be a part of as well as contribute to the social context. Overall, the participants’ view of the future was positive, and improvement in their health generated further confidence and encouragement. This study suggests that persons recovering from pancreaticoduodenectomy ad modum Whipple due to a pancreatic or periampullary tumour experience health despite postoperative symptoms. They manage their symptoms by means of different strategies and express a positive view of the future. Nurses working with such patients should adopt a person-centred approach focusing on patient perspectives, participation, and possibilities. Thomas Andersson, Kristin Falk, Kristofer Bjerså, and Anna Forsberg Copyright © 2012 Thomas Andersson et al. All rights reserved. How Does an Online Patient-Nurse Communication Service Meet the Information Needs of Men with Recently Diagnosed Testicular Cancer? Tue, 04 Dec 2012 07:26:20 +0000 Online communication has become a potential means of communication between patients and health care providers, but so far few studies are published about online communication as part of nursing care. The aim of this study was to explore how an online patient-nurse communication (OPNC) service meets the information needs of men with newly diagnosed testicular cancer. We applied a qualitative approach by examining the content of online messages sent by patients to nurses in a specialist cancer unit. In addition, individual interviews were conducted with patients who had used the OPNC service. Four themes became distinct through a synthesis of the material from the interviews and the messages: “a means for managing illness-related concerns at home,” “a means for ensuring information flow,” “a means for strategic information seeking,” and “not yet available when needed most.” Individualized information provided by nurses with access to their medical record was shown to be important to these patients. The findings of this study indicate that not only may access to an OPNC service help patients fulfill their otherwise unmet information needs, but also it may prevent delays and discontinuity in care due to informational gaps and lead to improved patient safety. Torunn Wibe, Ragnhild Hellesø, Cecilie Varsi, Cornelia Ruland, and Mirjam Ekstedt Copyright © 2012 Torunn Wibe et al. All rights reserved. Communication Training Improves Sense of Performance Expectancy of Public Health Nurses Engaged in Long-Term Elderly Prevention Care Program Mon, 19 Nov 2012 13:19:24 +0000 This study examines the effectiveness of a communication skill training based on a coaching theory for public health nurses (PHNs) who are engaged in Japan’s long-term care prevention program. The participants in this study included 112 PHNs and 266 service users who met with these PHNs in order to create a customized care plan within one month after the PHNs’ training. The participants were divided into three groups: a supervised group in which the PHNs attended the 1-day training seminar and the follow-up supervision; a seminar group attended only the 1-day training seminar; a control group. The PHNs’ sense of performance expectancy, and user’s satisfaction, user’s spontaneous behavior were evaluated at the baseline (T1), at one month (T2), and at three months (T3) after the PHNs’ training. At T3, the PHNs performed a recalled evaluation (RE) of their communication skills before the training. The PHNs’ sense of performance expectancy increased significantly over time in the supervised group and the control group , resp.). The difference score between T3-RE was significantly higher in the supervised group than the control group (). No significant differences in the users’ outcomes were found. Motoko Tanabe, Yoshimi Suzukamo, Ichiro Tsuji, and Sin-Ichi Izumi Copyright © 2012 Motoko Tanabe et al. All rights reserved. Predictors' Factors of Nutritional Status of Male Chronic Obstructive Pulmonary Disease Patients Wed, 14 Nov 2012 11:33:49 +0000 Chronic obstructive pulmonary disease (COPD) is a systemic disease that leads to weight loss and muscle dysfunction resulting in an increase in mortality. This study aimed to determine the prevalence rate of malnutrition and nutritional status and also factors associated with nutritional status. A total of 149 subjects were involved in the cross-sectional study. The study was conducted at two medical centers in Kuala Lumpur, Malaysia. The results of the study showed that malnutrition was more prevalent (52.4%) in the subjects with severe stages of COPD as compared to mild and moderate COPD stages (26.2%) (). Fat-free mass depletion as assessed using fat-free mass index (FFMI) affected 41.9% of the subjects. Plasma vitamin A, peak expiratory flow (PEF), and handgrip were the predictors for body mass index (BMI) (, ). Plasma vitamin A and force expiratory volume in one second (FEV1) were the predictors of FFMI (, ). BMI was the predictor of respiratory factors, that is, FEV1% predicted (, ). It can be concluded that there is a need to identify malnourished COPD patients for an appropriate nutrition intervention. Elham Pirabbasi, Mahin Najafiyan, Maria Cheraghi, Suzana Shahar, Zahara Abdul Manaf, Norfadilah Rajab, and Roslina Abdul Manap Copyright © 2012 Elham Pirabbasi et al. All rights reserved. Guided Self-Help for Prevention of Depression and Anxiety in Women with Breast Cancer Wed, 24 Oct 2012 09:16:09 +0000 Depression and anxiety are prevalent in women with breast cancer. We developed a self-help kit as a self-learning package of necessary preparatory information (basic knowledge on chemotherapy, side effects, and problem-solving skills). We provided an oncology nurse-guided self-help kit with a cognitive behavioral therapy approach to 46 women with breast cancer in the intervention group and usual care to 36 in the control group in outpatient chemotherapy settings. The oncology nurse monitored and facilitated the patient’s progress using the diary during the patient’s chemotherapy. We also provided professional-led support group programs. Depression, anxiety, and quality of life were measured at baseline, 1 week, 3 months, and 6 months. The chi-square test and t were used to examine differences between the two groups, and repeated measures analysis of variance was used to test the effects of the intervention on the measures over time. All depression and anxiety scores were improved in both the intervention and control groups, but there were no significant differences between the two groups. Further studies are needed to evaluate the effectiveness of an oncology nurse-guided self-help approach for cancer patients. Hiroko Komatsu, Naoko Hayashi, Kumi Suzuki, Kaori Yagasaki, Yukiko Iioka, Joyce Neumann, Seigo Nakamura, and Naoto T. Ueno Copyright © 2012 Hiroko Komatsu et al. All rights reserved. Translating Community Connectedness to Practice: A Qualitative Study of Midlevel Health Workers in Rural Guatemala Sun, 14 Oct 2012 15:49:45 +0000 Background. The performance of midlevel health workers is a critical lever for strengthening health systems and redressing inequalities in underserved areas. Auxiliary nurses form the largest cadre of health workers in Guatemala. In rural settings, they provide essential services to vulnerable communities, and thus have great potential to address priority health needs. This paper examines auxiliary nurses’ motivation and satisfaction, and the coping strategies they use to respond to challenges they confront in their practice. Methods. Semistructured interviews were conducted with 14 auxiliary nurses delivering health services in Alta Verapaz, Guatemala. Results. Community connectedness was central to motivation in this rural Guatemalan setting. Participants were from rural communities and conveyed a sense of connection to the people they were serving through shared culture and their own experiences of health needs. Satisfaction was derived through recognition from the community and a sense of valuing their work. Auxiliary nurses described challenges commonly faced in low-resource settings. Findings indicated they were actively confronting these challenges through their own initiative. Conclusions. Strategies to support the performance of midlevel health workers should focus on mechanisms to make training accessible to rural residents, support problem-solving in practice, and emphasize building relationships with communities served. Alison Hernández, Anna-Karin Hurtig, Kjerstin Dahlblom, and Miguel San Sebastián Copyright © 2012 Alison Hernández et al. All rights reserved. Counselling for Patients and Family Members: A Follow-Up Study in the Emergency Department Wed, 12 Sep 2012 08:04:55 +0000 Although the research indicates that patients and family members are not fully satisfied with the counselling they receive, little is known about the quality of counselling in more detail. The purpose of the study was to describe patients’ and their family members’ experiences about counselling in emergency department, and follow how these experiences possibly change after the educational intervention for the whole nursing staff of the ED ward. The pre-test-post-test follow-up design was implemented including online continuing education for ED staff. The data were collected via questionnaires from patients and their family members in two phases and analyzed statistically. After online education of staff, experiences of patients and family members concerning counselling were better than before the education. Especially, family members’ satisfaction had increased. However, our results also indicated that patients and family members desire more information for example, regarding medications. Care practices had developed towards family-centeredness, which patients and family members appreciate. Online education proved also in some degree its usefulness in educating ED staff, by offering the same education to a staff which works in shifts. Furthermore, family presence and participation practices should be developed by offering possibilities for families to stay with each other on ED ward. Eija Paavilainen, Mari Salminen-Tuomaala, and Päivi Leikkola Copyright © 2012 Eija Paavilainen et al. All rights reserved.