Nursing Research and Practice The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Barriers to Implementation of Evidence Based Practice in Zahedan Teaching Hospitals, Iran, 2014 Wed, 18 Mar 2015 11:43:55 +0000 This study aimed to determine the barriers to implementation of EBP among nurses. This cross-sectional study was conducted in Zahedan City, South East of Iran, in 2014. The questionnaire of barriers to implementation of EBP consists of 27 statements which was distributed among 280 nurses. More than half of the participants agreed that 56% and 57% of barriers to implementation of evidence based practice are related to organizational and individual aspects, respectively. Participants identified barriers at organizational level included the lack of human resources (78.3%), lack of internet access at work (72.2%), and heavy workload (70.0%). Barrier at individual level included lack of time to read literature (83.7%), lack of ability to work with computer (68.8%), and insufficient proficiency in English language (62.0%). Age, educational level, job experience, and employment status were associated with organizational barriers to implementation of EBP. At the individual level only education was associated with barriers to implementation of EBP. Barriers to implementation of EBP occur at both individual and organizational levels. The indicator of quality in nursing practice is EBP. Hence, familiarity with EBP is recommended for Iranian nurses. In addition, knowledge of barriers will help health care system and policy makers to provide a culture of EBP. Mohammad Khammarnia, Mahsa Haj Mohammadi, Zahra Amani, Shahab Rezaeian, and Fatemeh Setoodehzadeh Copyright © 2015 Mohammad Khammarnia et al. All rights reserved. Maternal Health Coping Strategies of Migrant Women in Norway Tue, 17 Mar 2015 14:31:52 +0000 The aim of the study was to explore the maternal health coping strategies of migrant women in Norway. The ethnic and cultural background of the Norwegian population have become increasingly diverse. A challenge in practice is to adjust maternal health services to migrant women’s specific needs. Previous studies have revealed that migrant women have difficulty achieving safe pregnancies and childbirths. Data were obtained by means of 17 semistructured interviews with women from South America, Europe, the Middle East, Asia, and Africa. Qualitative content analysis was employed. One overall theme is as follows: keeping original traditions while at the same time being willing to integrate into Norwegian society, and four themes emerged as follows: balancing their sense of belongingness; seeking information and support from healthcare professionals; being open to new opportunities and focusing on feeling safe in the new country. The results were interpreted in the light of Bronfenbrenner’s ecological model. To provide quality care, healthcare professionals should focus on the development of migrant women’s capabilities. Adaptation of maternal health services for culturally diverse migrant women also requires a culturally sensitive approach on the part of healthcare professionals. Berit Viken, Anne Lyberg, and Elisabeth Severinsson Copyright © 2015 Berit Viken et al. All rights reserved. Emergence: Complexity Pedagogy in Action Mon, 09 Mar 2015 08:33:31 +0000 Many educators are looking for new ways to engage students and each other in order to enrich curriculum and the teaching-learning process. We describe an example of how we enacted teaching-learning approaches through the insights of complexity thinking, an approach that supports the emergence of new possibilities for teaching-learning in the classroom and online. Our story begins with an occasion to meet with 10 nursing colleagues in a three-hour workshop using four activities that engaged learning about complexity thinking and pedagogy. Guiding concepts for the collaborative workshop were nonlinearity, distributed decision-making, divergent thinking, self-organization, emergence, and creative exploration. The workshop approach considered critical questions to spark our collective inquiry. We asked, “What is emergent learning?” and “How do we, as educators and learners, engage a community so that new learning surfaces?” We integrated the arts, creative play, and perturbations within a complexity approach. Christine Jonas-Simpson, Gail Mitchell, and Nadine Cross Copyright © 2015 Christine Jonas-Simpson et al. All rights reserved. Anti-Oppressive Practice and Reflexive Lifeworld-Led Approaches to Care: A Framework for Teaching Nurses about Social Justice Sun, 08 Mar 2015 13:47:44 +0000 This paper was initially written for a European Academy of Caring Science workshop and aimed to provide clarity and direction about Caring Science by offering some ideas emerging from the philosophy, themes, and projects of EACS. An underpinning concept for the work of the Academy is the lifeworld. The focus of the workshop was to explore the lifeworld of the patient, student, and carer. The intention was to promote discussion around the need to provide alternative ways to conceptualise caring relevant knowledge, naming phenomena and practices central to caring sciences, and the educational curriculum and its adequacy for caring science. This paper seeks to identify concepts and approaches to understanding oppression, power, and justice which enable nurses to challenge the structures in health care environments which discriminate or disempower clients. Anti-oppressive practice theory and reflexive lifeworld-led approaches to care enable nurses to be critical of their practice. A framework for teaching social justice in health care is offered to augment teaching students to challenge oppressive practice and to assist nurses to reflect and develop conceptual models to guide practices which are central to promoting caring interactions. Jacqueline Sarah Hutchison Copyright © 2015 Jacqueline Sarah Hutchison. All rights reserved. A Peer Health Educator Program for Breast Cancer Screening Promotion: Arabic, Chinese, South Asian, and Vietnamese Immigrant Women’s Perspectives Tue, 24 Feb 2015 11:42:02 +0000 This study explored Arabic, Chinese, South Asian, and Vietnamese immigrant women’s experiences with a peer health educator program, a public health program that facilitated access to breast health information and mammography screening. Framed within critical social theory, this participatory action research project took place from July 2009 to January 2011. Ten focus groups and 14 individual interviews were conducted with 82 immigrant women 40 years of age and older. Qualitative methods were utilized. Thematic content analysis derived from grounded theory and other qualitative literature was employed to analyze data. Four dominant themes emerged: Breast Cancer Prevention focused on learning within the program, Social Support provided by the peer health educator and other women, Screening Services Access for Women centered on service provision, and Program Enhancements related to specific modifications required to meet the needs of immigrant women accessing the program. The findings provide insights into strategies used to promote breast health, mammography screening, and the improvement of public health programming. Perceived barriers that continue to persist are structural barriers, such as the provision of information on breast cancer and screening by family physicians. A future goal is to improve collaborations between public health and primary care to minimize this barrier. Joanne Crawford, Angela Frisina, Tricia Hack, and Faye Parascandalo Copyright © 2015 Joanne Crawford et al. All rights reserved. Association between Washing Residue on the Feet and Tinea Pedis in Diabetic Patients Sun, 22 Feb 2015 12:05:31 +0000 Tinea pedis (TP) may lead to the development of foot ulcers in diabetic patients; thus, its prevention in diabetic patients is important. TP occurs after dermatophytes on the skin scales of TP patients attach to the feet. Therefore, it is necessary to remove the scales and dermatophytes, and this can be performed using various methods, including foot washing. This study aimed to objectively examine the association between the presence of TP and foot-washing habits. We included 33 diabetic patients, and, of these, 17 had TP. The presence of washing residue on the feet was determined by applying a fluorescent cream to the participants’ feet, and images of the feet were captured under ultraviolet light before and after foot washing. Our results showed that diabetic patients with TP had higher levels of washing residue on their feet than those without TP. The importance of washing feet to prevent TP needs to be emphasized through educational programs for diabetic patients. Furthermore, the development of an effective foot-washing technique is essential. Kimie Takehara, Ayumi Amemiya, Yuko Mugita, Yuichiro Tsunemi, Yoko Seko, Yumiko Ohashi, Kohjiro Ueki, Takashi Kadowaki, Makoto Oe, Takashi Nagase, Mari Ikeda, and Hiromi Sanada Copyright © 2015 Kimie Takehara et al. All rights reserved. Predictors of Patient Satisfaction with Tertiary Hospitals in Korea Thu, 05 Feb 2015 07:27:21 +0000 This study examined the general and system-related predictors of outpatient satisfaction with tertiary health care institutions in Korea. A cross-sectional descriptive study design was employed. The subjects were 1,194 outpatients recruited from 29 outpatient clinics of a university medical center in Korea. Measurements included 5 outpatient service domains (i.e., doctor service, nurse service, technician service, convenience, and physical environment of facility) and patient satisfaction. Of the five domains, nurse service was the domain with the highest mean score and convenience was the domain with the lowest mean score . The most significant predictor of patient satisfaction was the constructs of convenience . The results of this study suggest that the concept of patient satisfaction with health care institutions in modern hospitals reflects an integrative process that includes not only the concerned health care personnel but also improved convenience such as user-friendly reservation system and comfortable waiting areas. Hye-Sook Ham, Eun Hee Peck, Hee Soo Moon, and Hye-A Yeom Copyright © 2015 Hye-Sook Ham et al. All rights reserved. Australian Nurse Practitioner Practice: Value Adding through Clinical Reflexivity Thu, 29 Jan 2015 08:03:54 +0000 The role of the Australian Nurse Practitioner (NP) is in its infancy and at a crossroads where extensive research demonstrates effective quality care and yet the role remains underrecognised and underutilised. The translation of practice into “value” is critical for the sustainability of NP roles and requires the practitioner to adopt a systematic method of inquiry. Kim’s (1999) “Critical Reflective Inquiry” (CRI) method was adapted by two Australian NPs who specialise in diabetes and chronic disease management. Kim highlights the intent of CRI as understanding the meaning of practice, delivering improvements to practice through self-reflection, and the critique of practice that can lead to practice changes and development of new models of care translated to “products” of value. Based on the thematically analysis of 3 years of CRI application, the authors formed 5 headings that represented the NP’s practice as Specialised Care Access, Complications and Diagnostics Interventions, Pharmaceutical Treatment, Vulnerable Populations, and Leadership. The utility of CRI demonstrates how NP practice is integral to a continuous cycle of addressing health care services gaps, and the conversion of “products” into “value” and positions the NP to assimilate the role of the practitioner-researcher. Michelle Woods and Giuliana Murfet Copyright © 2015 Michelle Woods and Giuliana Murfet. All rights reserved. Identification of Pediatric Oral Health Core Competencies through Interprofessional Education and Practice Mon, 12 Jan 2015 06:51:52 +0000 Over the past seven years, the Department of Pediatric Dentistry at New York University College of Dentistry (NYUCD) and the Advanced Practice: Pediatrics and the Pediatric Nurse Practitioner (PNP) program at New York University College of Nursing (NYUCN) have engaged in a program of formal educational activities with the specific goals of advancing interprofessional education, evidence-based practice, and interprofessional strategies to improve the oral-systemic health of infants and young children. Mentoring interprofessional students in all health care professions to collaboratively assess, analyze, and care-manage patients demands that faculty reflect on current practices and determine ways to enhance the curriculum to include evidence-based scholarly activities, opportunities for interprofessional education and practice, and interprofessional socialization. Through the processes of interprofessional education and practice, the pediatric nursing and dental faculty identified interprofessional performance and affective oral health core competencies for all dental and pediatric primary care providers. Students demonstrated achievement of interprofessional core competencies, after completing the interprofessional educational clinical practice activities at Head Start programs that included interprofessional evidence-based collaborative practice, case analyses, and presentations with scholarly discussions that explored ways to improve the oral health of diverse pediatric populations. The goal of improving the oral health of all children begins with interprofessional education that lays the foundations for interprofessional practice. D. Hallas, J. B. Fernandez, N. G. Herman, and A. Moursi Copyright © 2015 D. Hallas et al. All rights reserved. Sexual Abuse of Older Nursing Home Residents: A Literature Review Tue, 06 Jan 2015 14:28:49 +0000 Despite an increasing literature related to elder abuse, sexual abuse of older persons in general and of vulnerable adults living in nursing homes in particular is still sparsely described. The purpose of this study was to assess the state of knowledge on the subject of sexual abuse against older nursing home residents through a literature review. Systematic searches in reference databases including Cinahl, Medline, OVID Nursing Database, ISI Web of Science, PsycINFO, Cochrane Library, and SveMed + were conducted. Through several phases of selection of the articles, using strict inclusion and exclusion criteria, six articles were chosen for a deeper examination. Findings from the review show that sexual abuse occurs in nursing homes and that both older women and men are victims of sexual abuse. Perpetrators appear mainly to be staff and other residents and mainly to be men, but also women abuse both older men and older women. Findings from the literature review show that there is a need for knowledge and further research on the topic of sexual abuse against older residents in nursing homes. Furthermore, there is a need for good policies and reporting systems, as an important step in seriously addressing sexual abuse against older persons. Wenche Malmedal, Maria Helen Iversen, and Astrid Kilvik Copyright © 2015 Wenche Malmedal et al. All rights reserved. Principles of Lifeworld Led Public Health Practice in the UK and Sweden: Reducing Health Inequalities Tue, 06 Jan 2015 08:40:34 +0000 The purpose of this paper is to consider the role of the lifeworld perspective in reducing inequalities in health and we explain how the public health practitioner can use this perspective to address public health issues with individuals and groups. We offer ideas for public health actions that are based on and deal with the lifeworld context of individual people or families. Each of the dimensions of the lifeworld temporality, spatiality, intersubjectivity, embodiment and mood are outlined and their significance explained in relation to health inequalities. Suggestions for action to reduce health inequalities are made and overall principles of lifeworld led public health practice are proposed by way of conclusion. The principles comprise understanding the community members’ lifeworld view, understanding their view of their potential, offering resources and facilitating empowerment, and sharing lifeworld case studies and lobbying to influence local and national policy in relation to both the individual and communities. Ann Hemingway, Liz Norton, and Clara Aarts Copyright © 2015 Ann Hemingway et al. All rights reserved. Freedom and Confinement: Patients’ Experiences of Life with Home Haemodialysis Thu, 18 Dec 2014 00:10:41 +0000 Patients with chronic end stage renal disease need dialysis to survive; however, they also need a treatment that suits their life situation. It is important that healthcare providers provide reliable, up-to-date information about different dialysis treatment options. Since home haemodialysis is a relatively new treatment, it is necessary to gather more knowledge about what the treatment entails from the patient’s perspective. The aim of this study was to describe patients’ experiences of having home haemodialysis. To gain access to the patients’ experiences, they were asked to write narratives, which describe both their good and bad experiences of life with the treatment. The narratives were analysed with a qualitative method. The results of this analysis are subdivided into five themes: freedom to be at home and control their own treatment, feeling of being alone with the responsibility, changes in the home environment, need for support, and security and well-being with home haemodialysis. The conclusion is that home haemodialysis provides a certain level of freedom, but the freedom is limited as the treatment itself is restrictive. In order to improve patients’ experiences with home haemodialysis, more research based on patients’ experiences is needed and it is necessary to involve the patients in the development of the care. C. Vestman, M. Hasselroth, and M. Berglund Copyright © 2014 C. Vestman et al. All rights reserved. Going around in a Circle: A Norwegian Study of Suicidal Experiences in Old Age Tue, 09 Dec 2014 09:18:03 +0000 Depression has repeatedly been found to be a risk factor for completed suicide, particularly when coupled with a pervasive sense of hopelessness. The aim of this study was to evaluate depressed older persons’ suicidal experiences. Data were collected by means of individual in-depth interviews with nine informants living in two districts of Norway. A hermeneutic analysis was performed. One main theme: Going around in a circle and two themes: being alone without meaning in life and struggling to achieve reconciliation emerged from the analysis. An important implication for mental healthcare practice is the need to develop a person’s ability to shape and take control of her/his life. The healthcare organisation must be committed to a plan that sets out strategies enabling suicidal individuals to avoid the negative experience of meaninglessness. It was concluded that suicidal depressed elderly persons need help to escape from their desperate situation. More research is urgently required in order to prevent suicide in depressed elderly persons whose emotional pain is unbearable. Anne Lise Holm, Anne Lyberg, Ingela Berggren, Sture Åström, and Elisabeth Severinsson Copyright © 2014 Anne Lise Holm et al. All rights reserved. Hypertension Education Intervention with Ugandan Nurses Working in Hospital Outpatient Clinic: A Pilot Study Mon, 08 Dec 2014 13:49:50 +0000 Noncommunicable diseases (NCDs) pose a significant global burden in both developed and developing countries. It is estimated that, by 2025, 41.7% of males and 38.7% of females in Sub-Saharan Africa will develop high blood pressure (HBP). This is particularly true in Uganda with hypertensive prevalence rates estimated to range from 22.5% to 30.5%. Coupled with low levels of detection, treatment, and control, hypertension represents a Ugandan public health crisis. An innovative WHO-ISH education program culturally was adapted in a pilot study and focused on knowledge, skills, and attitudes (KSA) of nurses caring for hypertensive patients in an outpatient clinic. Pre-post intervention data was collected and analyzed in which significant improvements were noted on all the three outcome measures. This pilot study demonstrated that nurses’ knowledge, skills, and attitudes could be significantly improved with a multimodal education program implemented in a low resource environment. Godfrey Katende, Sara Groves, and Kathleen Becker Copyright © 2014 Godfrey Katende et al. All rights reserved. Role Clarification Processes for Better Integration of Nurse Practitioners into Primary Healthcare Teams: A Multiple-Case Study Mon, 01 Dec 2014 07:58:22 +0000 Role clarity is a crucial issue for effective interprofessional collaboration. Poorly defined roles can become a source of conflict in clinical teams and reduce the effectiveness of care and services delivered to the population. Our objective in this paper is to outline processes for clarifying professional roles when a new role is introduced into clinical teams, that of the primary healthcare nurse practitioner (PHCNP). To support our empirical analysis we used the Canadian National Interprofessional Competency Framework, which defines the essential components for role clarification among professionals. A qualitative multiple-case study was conducted on six cases in which the PHCNP role was introduced into primary care teams. Data collection included 34 semistructured interviews with key informants involved in the implementation of the PHCNP role. Our results revealed that the best performing primary care teams were those that used a variety of organizational and individual strategies to carry out role clarification processes. From this study, we conclude that role clarification is both an organizational process to be developed and a competency that each member of the primary care team must mobilize to ensure effective interprofessional collaboration. Isabelle Brault, Kelley Kilpatrick, Danielle D’Amour, Damien Contandriopoulos, Véronique Chouinard, Carl-Ardy Dubois, Mélanie Perroux, and Marie-Dominique Beaulieu Copyright © 2014 Isabelle Brault et al. All rights reserved. How Public Health Nurses Identify and Intervene in Child Maltreatment Based on the National Clinical Guideline Wed, 19 Nov 2014 06:37:51 +0000 Objectives. To describe how Finnish public health nurses identify and intervene in child maltreatment and how they implement the National Clinical Guideline in their work. Design and Sample. Cross-sectional survey of 367 public health nurses in Finland. Measures. A web-based questionnaire developed based on the content areas of the guideline: identifying, intervening, and implementing. Results. The respondents reported they identify child maltreatment moderately (mean 3.38), intervene in it better (4.15), and implement the guideline moderately (3.43, scale between 1 and 6). Those with experience of working with maltreated children reported they identify them better , intervene better , and implement the guideline better than those with no experience. This difference was also found for those who were aware of the guideline, had read it, and participated in training on child maltreatment, as compared to those who were not aware of the guideline, had not read it, or had not participated in such training. Conclusions. The public health nurses worked quite well with children who had experienced maltreatment and families. However, the results point out several developmental targets for increasing training on child maltreatment, for devising recommendations for child maltreatment, and for applying these recommendations systematically in practice. Paavilainen Eija, Helminen Mika, Flinck Aune, and Lehtomäki Leila Copyright © 2014 Paavilainen Eija et al. All rights reserved. Mental Health Promotion in School: Schoolchildren’s and Families’ Viewpoint Wed, 19 Nov 2014 00:00:00 +0000 While developing mental health work in schools, it is very important to consider the viewpoint of pupils. Parents can also give remarkable information on their children’s viewpoint. The purpose of this study was to produce a description of the concepts used by schoolchildren aged 12–16 years and their families associated with promoting mental health in schools. The research material comprised interviews with schoolchildren and mothers, and verbal answers from the school well-being profile survey . The analysis was conducted by applying the grounded theory method as introduced by Strauss. The study was conducted in a Finnish comprehensive school. Kristiina Puolakka, Anne Konu, Irma Kiikkala, and Eija Paavilainen Copyright © 2014 Kristiina Puolakka et al. All rights reserved. Mental Health Nurses’ Experiences of Caring for Patients Suffering from Self-Harm Thu, 13 Nov 2014 06:52:51 +0000 The aim of this study was to explore mental health nurses’ experiences of caring for inpatients who self-harm during an acute phase. The setting was four psychiatric clinics in Norway. Fifteen mental health nurses (MHNs) were recruited. Semistructured interviews comprised the method for data collection, with content analysis used for data analysis. Two main categories emerged: challenging and collaborative nurse-patient relationship and promoting well-being through nursing interventions. The underlying meaning of the main categories was interpreted and formulated as a latent theme: promoting person-centered care to patients suffering from self-harm. How MHNs promote care for self-harm patients can be described as a person-centered nursing process. MHNs, through the creation of a collaborative nurse-patient relationship, reflect upon nursing interventions and seek to understand each unique patient. The implication for clinical practice is that MHNs are in a position where they can promote patients’ recovery processes, by offering patients alternative activities and by working in partnership with patients to promote their individual strengths and life knowledge. MHNs strive to help patients find new ways of living with their problems. The actual study highlighted that MHNs use different methods and strategies when promoting the well-being of self-harm patients. Randi Tofthagen, Anne-Grethe Talseth, and Lisbeth Fagerström Copyright © 2014 Randi Tofthagen et al. All rights reserved. The Unsteady Mainstay of the Family: Now Adult Children’s Retrospective View on Social Support in Relation to Their Parent’s Heart Transplantation Thu, 06 Nov 2014 12:56:39 +0000 The needs for support among children with a seriously ill parent, who is waiting for heart transplantation, are unknown today. The aim was to describe now adult children’s experiences of social support in relation to a parent’s heart transplant during childhood. Nine females and four males were interviewed. The median age for the children was 18 at the transplantation and their parents had been ill before for 18 months (median) and on waiting list for 161 days (mean). Three categories emerged: health care professionals’ approaches, family and friends’ approaches, and society approaches. Our results show that there was lack of support for children of heart transplantation patients. Support in the shape of information was in most cases provided by the sick or healthy parent. It is of great clinical importance to develop psychosocial support programs for children with a seriously ill parent waiting for heart transplantation (before, during, and after surgery). Susanna Ågren, Bodil Ivarsson, and Helén Rönning Copyright © 2014 Susanna Ågren et al. All rights reserved. Personnel’s Experiences of Phlebotomy Practices after Participating in an Educational Intervention Programme Thu, 30 Oct 2014 08:34:10 +0000 Background. Blood specimen collection is a common procedure in health care, and the results from specimen analysis have essential influence on clinical decisions. Errors in phlebotomy may lead to repeated sampling and delay in diagnosis and may jeopardise patient safety. This study aimed to describe the experiences of, and reflections on, phlebotomy practices of phlebotomy personnel working in primary health care after participating in an educational intervention programme (EIP). Methods. Thirty phlebotomists from ten primary health care centres participated. Their experiences were investigated through face-to-face interviews. Findings were analysed using qualitative content analysis. Results. The participants perceived the EIP as having opened up opportunities to reflect on safety. The EIP had made them aware of risks in relation to identification procedures, distractions from the environment, lack of knowledge, and transfer of information. The EIP also resulted in improvements in clinical practice, such as a standardised way of working and increased accuracy. Some said that the training had reassured them to continue working as usual, while others continued as usual regardless of incorrect procedure. Conclusions. The findings show that EIP can stimulate reflections on phlebotomy practices in larger study groups. Increased knowledge of phlebotomy practices improves the opportunities to revise and maximise the quality and content of future EIPs. Educators and safety managers should reflect on and pay particular attention to the identification procedure, distractions from the environment, and transfer of information, when developing and implementing EIPs. The focus of phlebotomy training should not solely be on improving adherence to practice guidelines. Karin Bölenius, Christine Brulin, and Ulla H. Graneheim Copyright © 2014 Karin Bölenius et al. All rights reserved. Kenyan Nurses Involvement in National Policy Development Processes Thu, 02 Oct 2014 00:00:00 +0000 The aim of this study was to critically examine how nurses have been involved in national policy processes in the Kenyan health sector. The paper reports qualitative results from a larger mixed method study. National nonnursing decision-makers and nurse leaders, and provincial managers as well as frontline nurse managers from two Kenyan districts were purposefully selected for interviews. Interviews dealt with nurses’ involvement in national policy processes, factors hindering nurses’ engagement in policy processes, and ways to enhance nurses’ involvement in policy processes. Critical theory and feminist perspectives guided the study process. Content analysis of data was conducted. Findings revealed that nurses’ involvement in policy processes in Kenya was limited. Only a few nurse leaders were involved in national policy committees as a result of their positions in the sector. Critical analysis of the findings revealed that hierarchies and structural factors as well as nursing professional issues were the primary barriers constraining nurses’ involvement in policy processes. Thus, there is need to address these factors both by nurses themselves and by nonnursing decision makers, in order to enhance nurses engagement in policy making and further the contribution to quality of services to the communities. Pamela Atieno Juma, Nancy Edwards, and Denise Spitzer Copyright © 2014 Pamela Atieno Juma et al. All rights reserved. “Like a Dance”: Performing Good Care for Persons with Dementia Living in Institutions Tue, 30 Sep 2014 12:44:25 +0000 Dementia care is demanding, and health care workers can become emotionally exhausted and frustrated. Particularly, demanding aspects of dementia care include patient agitation and care-resistant behaviour. The aim of this study is to describe skilled staff’s understanding of high-quality praxis in dementia care units in nursing homes. Eight nurses and care workers were individually interviewed, and a qualitative design was used. Participants were recruited from two nursing homes in two towns in eastern Norway. The data were analysed following the hermeneutic tradition inspired by Kvale. The analyses revealed three main findings describing good care: (a) to find: to identify the patient’s personal characteristics, state, and needs, (b) to follow: to choose the right time and the tempo and to adapt to the patient’s sensitivity, and (c) to lead: to be in the forefront and prepared and to change the patient’s state. An overall interpretation of the findings is described by the metaphor of a dance between the patient and the caregiver. Kristin Mjelde Helleberg and Solveig Hauge Copyright © 2014 Kristin Mjelde Helleberg and Solveig Hauge. All rights reserved. Timing Matters: HIV Testing Rates in the Emergency Department Tue, 09 Sep 2014 06:03:02 +0000 Study Objectives. In response to the 2010 New York State HIV testing law, we sought to understand the contextual factors that influence HIV testing rates in the emergency department (ED). Methods. We analyzed electronic health record logs from 97,655 patients seen in three EDs in New York City. We used logistic regression to assess whether time of day, day of the week, and season significantly affected HIV testing rates. Results. During our study period, 97,655 patients were evaluated and offered an HIV test. Of these, 7,763 (7.9%) agreed to be tested. Patients arriving between 6 a.m. and 7:59 p.m. were significantly () more likely to be tested for HIV, followed by patients arriving between 8:00 p.m. and 9:59 p.m. () and followed by patients arriving between 5–5:59 a.m. and 10–10:59 p.m. () compared to patients arriving at midnight. Seasonal variation was also observed, where patients seen in July, August, and September () were more likely to agree to be tested for HIV compared to patients seen in January, while patients seen in April and May () were less likely to agree to be tested for HIV. Conclusion. Time of day and season affect HIV testing rates in the ED, along with other factors such as patient acuity and completion of other blood work during the ED visit. These findings provide useful information for improving the implementation of an HIV testing program in the ED. Rebecca Schnall and Nan Liu Copyright © 2014 Rebecca Schnall and Nan Liu. All rights reserved. A Systematic Review of the Cost-Effectiveness of Nurse Practitioners and Clinical Nurse Specialists: What Is the Quality of the Evidence? Mon, 01 Sep 2014 00:00:00 +0000 Background. Improved quality of care and control of healthcare costs are important factors influencing decisions to implement nurse practitioner (NP) and clinical nurse specialist (CNS) roles. Objective. To assess the quality of randomized controlled trials (RCTs) evaluating NP and CNS cost-effectiveness (defined broadly to also include studies measuring health resource utilization). Design. Systematic review of RCTs of NP and CNS cost-effectiveness reported between 1980 and July 2012. Results. 4,397 unique records were reviewed. We included 43 RCTs in six groupings, NP-outpatient (), NP-transition (), NP-inpatient (), CNS-outpatient (), CNS-transition (), and CNS-inpatient (). Internal validity was assessed using the Cochrane risk of bias tool; 18 (42%) studies were at low, 17 (39%) were at moderate, and eight (19%) at high risk of bias. Few studies included detailed descriptions of the education, experience, or role of the NPs or CNSs, affecting external validity. Conclusions. We identified 43 RCTs evaluating the cost-effectiveness of NPs and CNSs using criteria that meet current definitions of the roles. Almost half the RCTs were at low risk of bias. Incomplete reporting of study methods and lack of details about NP or CNS education, experience, and role create challenges in consolidating the evidence of the cost-effectiveness of these roles. Faith Donald, Kelley Kilpatrick, Kim Reid, Nancy Carter, Ruth Martin-Misener, Denise Bryant-Lukosius, Patricia Harbman, Sharon Kaasalainen, Deborah A. Marshall, Renee Charbonneau-Smith, Erin E. Donald, Monique Lloyd, Abigail Wickson-Griffiths, Jennifer Yost, Pamela Baxter, Esther Sangster-Gormley, Pamela Hubley, Célyne Laflamme, Marsha Campbell–Yeo, Sheri Price, Jennifer Boyko, and Alba DiCenso Copyright © 2014 Faith Donald et al. All rights reserved. Implementation Intentions on the Effect of Salt Intake among Hypertensive Women: A Pilot Study Wed, 27 Aug 2014 15:19:21 +0000 This experimental study was aimed at assessing the potential effect of a theory-driven intervention—implementation intentions—on reducing salt intake among hypertensive Brazilian women. Ninety-eight participants were randomly assigned to participate in an implementation intentions intervention aimed at promoting lower salt intake through decreased addition of salt and salty spices to meals (intervention group, ; group, ). Endpoints were assessed at baseline and at the 2-month follow-up. Primary endpoints were a self-reporting measure of salt intake given by salt addition to meals (discretionary salt + salty spices = total added salt) and the 24 h urinary-sodium excretion. Secondary endpoints included intention, self-efficacy, and habit related to adding salt to meals. Patients in the intervention group showed a significant reduction in salt intake as assessed by 24 h urinary-sodium excretion. A significant reduction in the measure of habit was observed for both groups. No differences were observed for intention and self-efficacy. The results of this pilot study suggest the efficacy of planning strategies to help hypertensive women reduce their salt intake. Rúbia de Freitas Agondi, Marilia Estevam Cornélio, Roberta Cunha Matheus Rodrigues, and Maria-Cecilia Gallani Copyright © 2014 Rúbia de Freitas Agondi et al. All rights reserved. Information Experiences and Needs in Patients with Pulmonary Arterial Hypertension or Chronic Thromboembolic Pulmonary Hypertension Sun, 17 Aug 2014 00:00:00 +0000 Background. Pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) are fatal, noncurable, but treatable diseases that strongly affect the patients. Objective. To describe patients’ experience of information relating to PAH or CTEPH. Methods. A qualitative method using content analysis was applied. Seventeen patients (thirteen women and four men) aged 28–73 years from a regional PAH centre were individually interviewed. Results. Three categories that describe patients’ experiences of information emerged: handling of information, struggling with feelings that also affect others, and vulnerability associated with uncertainty. The patients would have welcomed more information to relatives from the healthcare professionals. Shortcomings on communicating a prognosis were experienced. The mediated information and knowledge gave the patients insight into physical or psychosocial problems. Mutual exchange of information between patients and healthcare professionals were marred by different experiences of attitudes, behaviour, and ownership. Conclusions. In the future, healthcare organizations must struggle to achieve a holistic healthcare by making it more person-centred, and they must also promote cooperation between PAH centres and local healthcare providers. It is essential to determine the most appropriate and valuable path of information and communication and, thereby, the most cost-effective management of PAH or CTEPH. Bodil Ivarsson, Björn Ekmehag, and Trygve Sjöberg Copyright © 2014 Bodil Ivarsson et al. All rights reserved. Validation of a New Instrument for Self-Assessment of Nurses’ Core Competencies in Palliative Care Wed, 16 Jul 2014 12:29:28 +0000 Competence can be seen as a prerequisite for high quality nursing in clinical settings. Few research studies have focused on nurses’ core competencies in clinical palliative care and few measurement tools have been developed to explore these core competencies. The purpose of this study was to test and validate the nurses’ core competence in palliative care (NCPC) instrument. A total of 122 clinical nurse specialists who had completed a postbachelor program in palliative care at two university colleges in Norway answered the questionnaire. The initial analysis, with structural equation modelling, was run in Mplus 7. A modified confirmatory factor analysis revealed the following five domains: knowledge in symptom management, systematic use of the Edmonton symptom assessment system, teamwork skills, interpersonal skills, and life closure skills. The actual instrument needs to be tested in a practice setting with a larger sample to confirm its usefulness. The instrument has the potential to be used to refine clinical competence in palliative care and be used for the training and evaluation of palliative care nurses. Kari Slåtten, Ove Hatlevik, and Lisbeth Fagerström Copyright © 2014 Kari Slåtten et al. All rights reserved. Implementation Intentions as a Strategy to Increase the Notification Rate of Potential Ocular Tissue Donors by Nurses: A Clustered Randomized Trial in Hospital Settings Tue, 15 Jul 2014 08:46:58 +0000 Aim. The purpose of this study is to evaluate the impact, among nurses in hospital settings, of a questionnaire-based implementation intentions intervention on notification of potential ocular tissue donors to donation stakeholders. Methods. This randomized intervention was clustered at the level of hospital departments with two study arms: questionnaire-based implementation intentions intervention and control. In the intervention group, nurses were asked to plan specific actions if faced with a number of barriers when reporting potential ocular donors. The primary outcome was the potential ocular tissue donors’ notification rate before and after the intervention. Analysis was based on a generalized linear model with an identity link and a binomial distribution. Results. We compared outcomes in 26 departments from 5 hospitals, 13 departments per condition. The implementation intentions intervention did not significantly increase the notification rate of ocular tissue donors (intervention: 23.1% versus control: 21.1%; , 2; ). Conclusion. A single and brief implementation intentions intervention among nurses did not modify the notification rate of potential ocular tissue donors to donation stakeholders. Low exposure to the intervention was a major challenge in this study. Further studies should carefully consider a multicomponent intervention to increase exposure to this type of intervention. Frédéric Douville, Gaston Godin, France Légaré, and Marc Germain Copyright © 2014 Frédéric Douville et al. All rights reserved. Applying Theory to Understand and Modify Nurse Intention to Adhere to Recommendations regarding the Use of Filter Needles: An Intervention Mapping Approach Thu, 10 Jul 2014 11:34:07 +0000 The manipulation of glass ampoules involves risk of particle contamination of parenteral medication, and the use of filter needles has often been recommended in order to reduce the number of particles in these solutions. This study aims to develop a theory-based intervention to increase nurse intention to use filter needles according to clinical guideline recommendations produced by a large university medical centre in Quebec (Canada). Using the Intervention Mapping framework, we first identified the psychosocial determinants of nurse intention to use filter needles according to these recommendations. Second, we developed and implemented an intervention targeting nurses from five care units in order to increase their intention to adhere to recommendations on the use of filter needles. We also assessed nurse satisfaction with the intervention. In total, 270 nurses received the intervention and 169 completed the posttest questionnaire. The two determinants of intention, that is, attitude and perceived behavioral control, were significantly higher after the intervention, but only perceived behavioral control remained a predictor of intention. In general, nurses were highly satisfied with the intervention. This study provides support for the use of Intervention Mapping to develop, implement, and evaluate theory-based interventions in order to improve healthcare professional adherence to clinical recommendations. Julianne Cassista, Julie Payne-Gagnon, Brigitte Martel, and Marie-Pierre Gagnon Copyright © 2014 Julianne Cassista et al. All rights reserved. Minority Breast Cancer Survivors: The Association between Race/Ethnicity, Objective Sleep Disturbances, and Physical and Psychological Symptoms Wed, 02 Jul 2014 11:45:07 +0000 Background. Limited research has been conducted on the moderating effect of race/ethnicity on objective sleep disturbances in breast cancer survivors (BCSs). Objective. To explore racial/ethnic differences in objective sleep disturbances among BCSs and their relationship with self-reported symptoms. Intervention/Methods. Sleep disturbance and symptoms were measured using actigraphy for 72 hours and self-reported questionnaires, respectively, among 79 BCSs. Analysis of covariance, Pearson’s correlation, and multivariate regression were used to analyze data. Results. Sixty (75.9%) participants listed their ethnicity as white, non-Hispanic and 19 (24.1%) as minority. Total sleep time was 395.9 minutes for white BCSs compared to 330.4 minutes for minority BCSs. Significant correlations were seen between sleep onset latency (SOL) and depression, SOL and fatigue, and sleep efficiency (SE) and fatigue among minority BCSs. Among white BCSs, significant correlations were seen between SE and pain and wake after sleep onset (WASO) and pain. The association between depression and SOL and fatigue and SOL appeared to be stronger in minority BCSs than white BCSs. Conclusions. Results indicate that white BCSs slept longer than minority BCSs, and race/ethnicity modified the effect of depression and fatigue on SOL, respectively. Implications for Practice. As part of survivorship care, race/ethnicity should be included as an essential component of comprehensive symptom assessments. Pinky H. Budhrani, Cecile A. Lengacher, Kevin E. Kip, Cindy Tofthagen, and Heather Jim Copyright © 2014 Pinky H. Budhrani et al. All rights reserved.