http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2013 , Hindawi Publishing Corporation . All rights reserved. Thu, 16 May 2013 12:48:50 +0000 http://www.hindawi.com/journals/nrp/2013/794743/ In order to deliver effective care, it is necessary to organise interdisciplinary activities for older persons who suffer from depressive disorders. This paper evaluated the interdisciplinary team members’ perceptions of cooperation in the discharge planning of depressed older persons based on the Chronic Care Model (CCM). A qualitative implementation design was used, data were collected by means of multistage focus groups, and a thematic analysis was performed. Three themes emerged: lack of effective team leadership in the community, the need to change the delivery system, and enhancing self-management support for depressed older persons as well as the participation of their families. It was concluded that nurse managers must find ways of supporting the depressed older persons by better structuring the care, increasing cooperation with organisational leadership, and creating an environment characterised by trust and mutual respect. Distrust can have serious implications for discharge planning collaboration. The development of a common vision of transparency in the organization is important as is a policy of change among leadership and in clinical practice. Anne Lise Holm and Elisabeth Severinsson Copyright © 2013 Anne Lise Holm and Elisabeth Severinsson. All rights reserved. Thu, 16 May 2013 09:12:14 +0000 http://www.hindawi.com/journals/nrp/2013/181670/ Older persons in transition to need professional care in their homes will constitute a large group in municipalities in the future. The aim of this study was to obtain insight into nurses' experiences and perceptions of caring for patients in transition to receive homecare. Eleven home nurses divided into two focus groups were interviewed, and a phenomenological hermeneutical design was used. Four interpretations closely related to each other were revealed: it is essential to have an understanding of the patients' transition history; the nurse' repertoire is challenged in the transition process; care must be adapted to the patients' life world; the excellence of care is threatened by the context. The nurses strived to provide care based upon respect for the independent individual as a living whole. Their ambitions were, however, challenged and threatened by the caring context. The cooperation across organizational levels was pointed out as a critical factor with potential for improvement. This must be taken seriously to support the nurses in their endeavors to provide excellent care. Sigrun Hvalvik and Bjørg Dale Copyright © 2013 Sigrun Hvalvik and Bjørg Dale. All rights reserved. Tue, 07 May 2013 13:32:18 +0000 http://www.hindawi.com/journals/nrp/2013/987463/ Unmanaged maternal opioid addiction poses health and social risks to both mothers and children in their care. Methadone maintenance treatment (MMT) is a targeted public health service to which nurses and other allied health professionals may refer these high risk families for support. Mothers participating in MMT to manage their addiction and their service providers were interviewed to identify resources to maximize mothers’ engagement in treatment and enhance mothers’ parenting capacity. Twelve mothers and six service providers were recruited from an outpatient Atlantic Canadian methadone treatment program. Two major barriers to engagement in MMT were identified by both mothers and service providers including (1) the lack of available and consistent childcare while mothers attended outpatient programs and (2) challenges with transportation to the treatment facility. All participants noted the potential benefits of adding supportive resources for the children of mothers involved in MMT and for mothers to learn how to communicate more effectively with their children and rebuild damaged mother-child relationships. The public health benefits of integrating parent-child ancillary supports into MMT for mothers are discussed. Nicole Letourneau, Mary Ann Campbell, Jennifer Woodland, and Jennifer Colpitts Copyright © 2013 Nicole Letourneau et al. All rights reserved. Tue, 07 May 2013 13:29:19 +0000 http://www.hindawi.com/journals/nrp/2013/672702/ The aim of this qualitative systematic review was to report a synthesis of older persons’ perceptions of health, ill health, and their community health care needs. The review questions were what characterizes older persons’ perceptions of health and ill health? and what are their community health care needs? Ten studies were identified in a systematic search for relevant qualitative papers published between January 2000 and January 2013 in the following electronic databases: PubMed, EBSCOhost/Academic Search Premier, and CINAHL. Publications were evaluated for quality, and a thematic analysis was performed. Two main themes were interpreted on a higher level: reconciliation with how life has become: and desire to regain their identity and sense of self-worth despite disability. Two themes emerged: creating meaning led to the experience of being valued in health care and society and a mental struggle to regain independence with the help of caregivers. Of special interest is the finding of perceptions related to the fear of becoming dependent on caregivers as well as the sorrow and pain caused by encountering caregivers who did not understand their desire to create meaning in their lives or their struggle for autonomy and independency. Anne Lise Holm and Elisabeth Severinsson Copyright © 2013 Anne Lise Holm and Elisabeth Severinsson. All rights reserved. Mon, 29 Apr 2013 14:52:25 +0000 http://www.hindawi.com/journals/nrp/2013/848567/ Background. Research related to prevention of maternal to child transmission (PMTCT) of HIV is dynamic and rapidly changing and has provided evidence-based interventions and policies for practitioners. However, it is uncertain that research and policy guidelines are adequately being disseminated and implemented in resource-constrained countries with the largest burden PMTCT. This study examined current PMTCT practices in 27 public health facilities in Nigeria. Methods. A cross-sectional survey of 231 practicing nurses was conducted. Current PMTCT care practices were evaluated and compared to WHO and national PMTCT policy guidelines. Linear mixed models evaluated the association between PMTCT care practices and training in PMTCT. Results. Most nurses (80%) applied practices involving newborn prophylaxis; yet significant gaps in maternal intrapartum treatment and infant feeding practices were identified. PMTCT training explained 25% of the variance in the application of PMTCT care practices. Conclusion. Key PMTCT practices are not being adequately translated from research into practice. Researchers, policymakers, and clinicians could apply the study findings to address significant knowledge translation gaps in PMTCT. Strategies derived from an implementation science perspective are suggested as a means to improve the translation of PMTCT research into practice in Sub-Saharan African medical facilities. Y. Ogbolu, E. N. Iwu, S. Zhu, and J. V. Johnson Copyright © 2013 Y. Ogbolu et al. All rights reserved. Tue, 23 Apr 2013 10:39:42 +0000 http://www.hindawi.com/journals/nrp/2013/695820/ The purpose of the study was to evaluate changes in general self-efficacy, health related quality of life (HRQoL), and stress among patients with neuroendocrine tumors (NET) following a multidisciplinary educational intervention. Forty-one patients were enrolled in this exploratory pilot study. A total of 37 patients completed the full 26-week intervention based on the principles of self-efficacy. General self-efficacy was measured by the General Self-Efficacy Scale, HRQoL was measured with the SF-36, and stress was measured with the Impact of Event Scale. Mixed effect models were used to evaluate changes in general self-efficacy, mental and physical components of HRQoL, and stress adjusting for demographic and clinical variables. Results showed significant improvements in patients’ general self-efficacy ( = 0.71; ), physical component scores of HRQoL ( = 3.09; ), and stress (, ). Findings suggest that patients with NET have the capacity to improve their ability to cope with their disease, problem-solve, improve their physical status, and reduce their stress following an educational intervention based on the principles of self-efficacy. These preliminary data provide a basis for future randomized controlled trials to test interventions to improve HRQoL for patients with NET. Trude Haugland, Marijke Veenstra, Morten H. Vatn, and Astrid K. Wahl Copyright © 2013 Trude Haugland et al. All rights reserved. Tue, 23 Apr 2013 10:03:16 +0000 http://www.hindawi.com/journals/nrp/2013/548591/ The purpose of this paper is to report the variance in institutional review board (IRB) reviews as part of the implementation of a multisite, quality improvement study through the Improvement Science Research Network (ISRN) and recommend strategies successful in procuring timely IRB approval. Using correspondence documents as data sources, the level of review was identified and time to submission, time to approval, and time to study start were analyzed. Thirteen of the 14 IRBs conducted independent reviews of the project. Twelve IRBs approved the study through expedited review while two IRBs reviewed the project at a full board meeting. Lastly, 11 of the 14 sites required documented consent. The greatest delay in approval was seen early on in the IRB process with site PIs averaging 45.1 ± 31.8 days to submit the study to the IRB. IRB approvals were relatively quick with an average of 14 ± 5.7 days to approval. The delay in study submission may be attributed to a lack of clear definitions and differing interpretations of the regulations that challenge researchers. Darpan I. Patel, Kathleen R. Stevens, and Frank Puga Copyright © 2013 Darpan I. Patel et al. All rights reserved. Wed, 17 Apr 2013 15:23:26 +0000 http://www.hindawi.com/journals/nrp/2013/417010/ Posttraumatic stress disorder (PTSD) develops in approximately one-quarter of trauma-exposed individuals, leading us and others to question the mechanisms underlying this heterogeneous response to trauma. We suggest that the reasons for the heterogeneity relate to a complex interaction between genes and the environment, shaping each individual’s recovery trajectory based on both historical and trauma-specific variables. Epigenetic modifications provide a unique opportunity to elucidate how preexisting risk factors may contribute to PTSD risk through changes in the methylation of DNA. Preexisting risks for PTSD, including depression, stress, and trauma, result in differential DNA methylation of endocrine genes, which may then result in a different biological responses to trauma and subsequently a greater risk for PTSD onset. Although these relationships are complex and currently inadequately described, we provide a critical review of recent studies to examine how differences in genetic and proteomic biomarkers shape an individual’s vulnerability to PTSD development, thereby contributing to a heterogeneous response to trauma. Morgan Heinzelmann and Jessica Gill Copyright © 2013 Morgan Heinzelmann and Jessica Gill. All rights reserved. Sun, 14 Apr 2013 17:19:32 +0000 http://www.hindawi.com/journals/nrp/2013/469070/ Major depressive disorder (MDD) affects millions of individuals and causes significant suffering worldwide. It has been speculated that MDD is associated with accelerated aging-related biological and functional decline. To examine the accelerated aging hypothesis, one of the biomarkers under study is leukocyte telomeres, and specifically the measure of telomere length and telomerase activity. This review integrates findings from eleven human studies which evaluated telomere length and telomerase activity, in order to synthesize the state of the current science and to inform the development of new knowledge and enhance nursing research of depression using appropriate biobehavioral measures. Although preliminary, the findings from this integrated review suggest that there is evidence to support a conceptualization of depression as a stress-related condition in which telomeres shorten over time in relation to cumulative exposure to the chronic stress of depression. For the purposes of testing in future nursing research, visual representations of the theoretical connection between stress vulnerabilities, depression, and health outcomes and key moderators and mediators involved in this conceptualization are provided. The findings from this review and the conceptual framework provided may be a useful step towards advancing therapeutic nursing interventions for this debilitating chronic condition. Patricia Anne Kinser and Debra E. Lyon Copyright © 2013 Patricia Anne Kinser and Debra E. Lyon. All rights reserved. Tue, 09 Apr 2013 08:51:21 +0000 http://www.hindawi.com/journals/nrp/2013/860396/ Background. People with spinal cord injury (SCI) are at increased risk of pressure ulcers due to prolonged periods of sitting. Concordance with pressure relieving movements is poor amongst this population, and one potential alternative to improve this would be to integrate pressure relieving movements into everyday functional activities. Objectives. To investigate both the current pressure relieving behaviours of SCI individuals during computer use and the application of an ergonomically adapted computer-based activity to reduce interface pressure. Design. Observational and repeated measures design. Setting. Regional Spinal Cord Injury Unit. Participants. Fourteen subjects diagnosed with SCI (12 male, 2 female). Intervention.Comparing normal sitting to seated movements and induced forward reaching positions. Main Outcome Measures. Interface pressure measurements: dispersion index (DI), peak pressure index (PPI), and total contact area (CA). The angle of trunk tilt was also measured. Results. The majority of movements yielded less than 25% reduction in interface pressure compared to normal sitting. Reaching forward by 150% of arm length during an adapted computer activity significantly reduced DI (), angle of trunk tilt (p<0.05), and PPI for both ischial tuberosity regions () compared to normal sitting. Conclusion. Reaching forward significantly redistributed pressure at the seating interface, as evidenced by the change in interface pressures compared to upright sitting. May Stinson, Rachel Schofield, Cathy Gillan, Julie Morton, Evie Gardner, Stephen Sprigle, and Alison Porter-Armstrong Copyright © 2013 May Stinson et al. All rights reserved. Mon, 08 Apr 2013 11:20:44 +0000 http://www.hindawi.com/journals/nrp/2013/186414/ Child maltreatment is a global problem and a multidimensional phenomenon occurring in all social classes. This study depicts interprofessional collaboration associated with the detection of and early intervention in child maltreatment taking place in the family. The data were collected in a large Finnish city, Tampere (207 866 citizens). A survey was administered to employees in day care, basic education, social and health services, and police (). The results indicate that interprofessional collaboration associated with the detection of and intervention in child maltreatment was best accomplished by social service employees and police personnel. Employees in day care, basic education, health services, and police had little knowledge of the methods used in other units. The most support for collaboration was reported by employees in social services and day care. The results provide basic knowledge of interprofessional collaboration associated with child maltreatment between the agencies involved in the study. The research evidence can also be utilized in an international context when developing collaboration between different fields. Jaana Inkilä, Aune Flinck, Tiina Luukkaala, Päivi Åstedt-Kurki, and Eija Paavilainen Copyright © 2013 Jaana Inkilä et al. All rights reserved. Thu, 04 Apr 2013 10:16:04 +0000 http://www.hindawi.com/journals/nrp/2013/427917/ Older adults have long been encouraged to maintain their autonomy by expressing their wishes for health care before they become too ill to meaningfully participate in decision making. This study explored the manner in which community-dwelling adults aged 55 and older plan for serious illness. An online survey was conducted within the province of Saskatchewan, Canada, with 283 adults ranging in age from 55 to 88 years. Planning for future medical care was important for the majority (78.4%) of respondents, although only 25.4% possessed a written advance care plan and 41.5% had designated a substitute decision maker. Sixty percent of respondents reported conversations about their treatment wishes; nearly half had discussed unacceptable states of health. Associations between key predictor variables and planning behaviors (discussions about treatment wishes or unacceptable states of health; designation of a substitute decision maker; preparation of a written advance care plan) were assessed using binary logistic regression. After controlling for all predictor variables, self-reported knowledge about advance care planning was the key variable significantly associated with all four planning behaviors. The efforts of nurses to educate older adults regarding the process of advance care planning can play an important role in enhancing autonomy. Donna Goodridge Copyright © 2013 Donna Goodridge. All rights reserved. Thu, 04 Apr 2013 09:57:24 +0000 http://www.hindawi.com/journals/nrp/2013/932381/ Going into a nursing home can turn out to be a critical life experience if elderly people are afraid of losing their independence and identity after having moved into a nursing home. In order to find out what nursing home residents need in their first year after having moved into a nursing home to maintain their identity and self-determination, 20 problem-orientated interviews with residents of three nursing homes in the Austrian province of Salzburg were conducted and analysed based on content analysis according to Mayring. The participants of this study resist against having decisions taken away from them and fight for their independence and identity. In order to be able to cope with these strains, they need the help of family members, professionals, and identity-forming conversations in new social networks in the nursing home. The study participants draw enough strength from their faith in order to fight for their independence. They develop a new identity close to their previous identity by maintaining autonomy and mobility with a clear focus on the future. Maria Riedl, Franco Mantovan, and Christa Them Copyright © 2013 Maria Riedl et al. All rights reserved. Sun, 31 Mar 2013 16:32:30 +0000 http://www.hindawi.com/journals/nrp/2013/426107/ Health of populations is determined by a multitude of contextual factors. Primary Health Care Reform endeavors to meet the broad health needs of populations and remains on international health agendas. Public health nurses are key professionals in the delivery of primary health care, and it is important for them to learn from global experiences. International collaboration is often facilitated by academic exchanges. As a result of one such exchange, an international PHN collaboration took place. The aim of this paper is to analyse the similarities and differences in public health nursing in Ireland and Norway within the context of primary care. Anne Clancy, Patricia Leahy-Warren, Mary Rose Day, and Helen Mulcahy Copyright © 2013 Anne Clancy et al. All rights reserved. Sat, 30 Mar 2013 14:01:13 +0000 http://www.hindawi.com/journals/nrp/2013/605757/ Objective. To describe a comprehensive strategy for implementing an effective diabetes self-management support intervention incorporating goal-setting and followup support in community health clinics (CHCs) serving vulnerable patients. Methods. The Replicating Effective Programs (REP) framework was applied to develop an intervention strategy. In order to create a strategy consistent with the REP framework, four CHCs engaged in an iterative process involving key-informant interviews with clinic staff, ongoing involvement of clinic staff facilitating translational efforts, feedback from national experts, and an instructional designer. Results. Moving through the REP process resulted in an implementation strategy that aims to facilitate commitment, communication, and change at the clinic level, as well as means of providing interactive, time-limited education about patient behavior change and support to health care providers. Conclusion. The REP offered a useful framework for providing guidance toward the development of a strategy to implement a diabetes self-management intervention in CHCs serving medically underserved and underrepresented patient populations. Andrea S. Wallace, Andrew L. Sussman, Mark Anthoney, and Edith A. Parker Copyright © 2013 Andrea S. Wallace et al. All rights reserved. Wed, 27 Mar 2013 13:03:58 +0000 http://www.hindawi.com/journals/nrp/2013/365329/ Background. Nurses who provide end of life and bereavement care to neonates and their families are potentially at risk for developing stress-related health problems. These health problems can negatively affect nurses’ ability to care for their patients. Purpose. Nurses need to be knowledgeable about end of life and bereavement issues to provide quality care. This study sought to evaluate the effect of a bereavement seminar on the attitudes of nurses regarding end of life and palliative care of neonates. Design. A convenience sample of fourteen neonatal nurses completed a Bereavement/End of Life Attitudes about Care of Neonatal Nurses Scale after a bereavement seminar designed to provide information on end of life care. A pre- and posttest design with an intervention and control group was used to assess changes in nurse bereavement attitudes in relationship to comfort, role, and involvement. Results. After bereavement seminar, the seminar attendees had higher levels of comfort in providing end of life care than nurses in the control group (; = 0.04). Discussion. Nurses' comfort levels can be improved by attending continuing education on end of life care and having their thoughts on ethical issues in end of life care acknowledged by their peers. Weihua Zhang and Betty S. Lane Copyright © 2013 Weihua Zhang and Betty S. Lane. All rights reserved. Wed, 27 Mar 2013 11:59:04 +0000 http://www.hindawi.com/journals/nrp/2013/909606/ Dissemination and implementation (D&I) research is a growing area of science focused on overcoming the science-practice gap by targeting the distribution of information and adoption of interventions to public health and clinical practice settings. This study examined D&I research projects funded under specific program announcements by the US National Institutes of Health (NIH) from 2005 to 2012. The authors described the projects’ D&I strategies, funding by NIH Institute, focus, characteristics of the principal investigators (PIs) and their organizations, and other aspects of study design and setting. Results showed 46 R01s, 6 R03s, and 24 R21s funded totaling $79.2 million. The top funders were the National Cancer Institute and the National Institute of Mental Health, together providing 61% of funding. The majority of PIs were affiliated with Schools of Medicine or large, nonprofit research organizations and think tanks. Only 4% of projects were to PIs with appointments at Schools of Nursing, with 7% of the funding. The most commonly funded projects across all of the studies focused on cancer control and screening, substance abuse prevention and treatment, and mental health services. Typically implemented in community and organizational settings, D&I research provides an excellent opportunity for team science, including nurse scientists and interdisciplinary collaborators. Mindy Tinkle, Richard Kimball, Emily A. Haozous, George Shuster, and Robin Meize-Grochowski Copyright © 2013 Mindy Tinkle et al. All rights reserved. Tue, 26 Mar 2013 15:12:43 +0000 http://www.hindawi.com/journals/nrp/2013/630239/ The establishment of a system for providing appropriate long-term care services for older people is a national issue in Japan, and it will likely become a worldwide issue in the years to come. Under Japanese Long-term Care Insurance System, long-term care is provided based on long-term care programs, which were designed by care providers on the basis of long-term care service plans, which were designed by care managers. However, defined methodology for designing long-term care service plans and care programs has not been established yet. In this paper, we propose models for designing long-term care service plans and care programs for older people, both by incorporating the technical issues from previous studies and by redesigning the total methodology according to these studies. Our implementation model consists of “Function,” “Knowledge Structure,” and “Action Flow.” In addition, we developed the concrete knowledgebases based on the Knowledge Structure by visualizing, summarizing, and structuring the inherent knowledge of healthcare/welfare professionals. As the results of the workshop and retrospective verification, the adequacy of the models was suggested, while some further issues were pointed. Our models, knowledgebases, and application make it possible to ensure the quality of long-term care for older people. Shogo Kato, Satoko Tsuru, and Yoshinori Iizuka Copyright © 2013 Shogo Kato et al. All rights reserved. Tue, 26 Mar 2013 14:28:07 +0000 http://www.hindawi.com/journals/nrp/2013/265247/ The purpose of this paper is to explore whether and how workers in a crisis resolution home treatment (CRHT) team experience the relationship between their personal history and professional role. This paper is based on 13 in-depth interviews with health professionals working in CRHT. The interviews were analysed using a hermeneutic-phenomenological approach. Participants expressed that there is a relationship between their personal history and professional role, and three themes are highlighted as particularly important in, namely experiences related to the participants as individuals, work-related experiences and family-related experiences. The participants write meaning into the relationship between their personal history and professional role. By relating and exploring their own life stories in the interviews, they work on forming meaning and identity. Hege Sjølie, Bengt Karlsson, and Per-Einar Binder Copyright © 2013 Hege Sjølie et al. All rights reserved. Sun, 24 Mar 2013 10:37:17 +0000 http://www.hindawi.com/journals/nrp/2013/923137/ This research sought to better understand how older female spouses cope with a partner’s coronary artery bypass graft surgery and to explore coping’s relationships with life-change stress, cognitive appraisal, resilience, social support, and aspects of spouse’s surgery. A sample of 96 women, aged from 55 to 81 years, completed surveys after their partner’s surgery. Folkman and Lazarus’ ways of coping (WCQ) scales yielded two factors in this sample—reactive coping and adaptive coping. Reactive coping, including more emotion-focused ways of coping from the WCQ, was associated only with more time spent anticipating spouses’ surgeries. Women described the greatest use of ways of coping labeled adaptive, which in turn had significant relationships with greater resilience, social support, and positive appraisal of the surgical experience. Stepwise multiple regression found greater resilience, more frequent religious participation, and fewer children to be distinct predictors of adaptive coping. Nursing staff are encouraged to accept and normalize reactive coping, while facilitating adaptive coping with surgical stresses. Suzanne Marnocha and Mark Marnocha Copyright © 2013 Suzanne Marnocha and Mark Marnocha. All rights reserved. Thu, 21 Mar 2013 14:35:08 +0000 http://www.hindawi.com/journals/nrp/2013/785025/ Cross-sectional study compares the perception and attitudes about violence against women of physicians and nurses working in the primary health care clinics in Ribeirão Preto, SP. A total of 170 physicians and 51 nurses were interviewed in the District Health Clinics. Physicians feel more comfortable than nurses to talk about the sex life of patients () and to investigate the use of drugs (0.001). Compared to the nurses greater number of physicians believed that the aggression to the woman by the husband should be treated as a medical problem (). Both believe that external factors, as alcohol or drug abuse, unemployment, and psychological problems of the husband and not of the victim, can cause violent acts. Most interviewees understand that gender violence exceeds the issues of individuality and privacy and has become a public health problem, by the dimension present in the social relationships. Ana Cyntia Paulin Baraldi, Ana Maria de Almeida, Gleici Perdoná, Elisabeth Meloni Vieira, and Manoel Antonio dos Santos Copyright © 2013 Ana Cyntia Paulin Baraldi et al. All rights reserved. Wed, 20 Mar 2013 14:58:22 +0000 http://www.hindawi.com/journals/nrp/2013/581012/ This meta-analysis assessed how successfully Diabetes Self-Management Education (DSME) interventions help people with type 2 diabetes achieve and maintain healthy blood glucose levels. We included 52 DSME programs with 9,631 participants that reported post-intervention A1c levels in randomized controlled trials. The training conditions resulted in significant reductions in A1c levels compared to control conditions. However, the impact of intervention was modest shifting of only 7.23% more participants from diabetic to pre-diabetic or normal status, relative to the control condition. Most intervention participants did not achieve healthy A1c levels. Further, few DSME studies assessed long-term maintenance of A1c gains. Past trends suggest that gains are difficult to sustain over time. Our results suggested that interventions delivered by nurses were more successful than those delivered by non-nursing personnel. We suggest that DSME programs might do better by going beyond procedural interventions. Most DSME programs relied heavily on rules and procedures to guide decisions about diet, exercise, and weight loss. Future DSME may need to include cognitive self-monitoring, diagnosis, and planning skills to help patients detect anomalies, identify possible causes, generate corrective action, and avoid future barriers to maintaining healthy A1c levels. Finally, comprehensive descriptions of DSME programs would advance future efforts. Helen Altman Klein, Sarah M. Jackson, Kenley Street, James C. Whitacre, and Gary Klein Copyright © 2013 Helen Altman Klein et al. All rights reserved. Wed, 20 Mar 2013 11:50:26 +0000 http://www.hindawi.com/journals/nrp/2013/798213/ Little is known about how to systematically integrate complex qualitative studies within the context of randomized controlled trials. A two-phase sequential explanatory mixed methods study was conducted in Canada to understand how women decide to disclose intimate partner violence in emergency department settings. Mixing a RCT (with a subanalysis of data) with a grounded theory approach required methodological modifications to maintain the overall rigour of this mixed methods study. Modifications were made to the following areas of the grounded theory approach to support the overall integrity of the mixed methods study design: recruitment of participants, maximum variation and negative case sampling, data collection, and analysis methods. Recommendations for future studies include: (1) planning at the outset to incorporate a qualitative approach with a RCT and to determine logical points during the RCT to integrate the qualitative component and (2) consideration for the time needed to carry out a RCT and a grounded theory approach, especially to support recruitment, data collection, and analysis. Data mixing strategies should be considered during early stages of the study, so that appropriate measures can be developed and used in the RCT to support initial coding structures and data analysis needs of the grounded theory phase. Cristina Catallo, Susan M. Jack, Donna Ciliska, and Harriet L. MacMillan Copyright © 2013 Cristina Catallo et al. All rights reserved. Sun, 17 Mar 2013 16:58:12 +0000 http://www.hindawi.com/journals/nrp/2013/814360/ Healthcare is a complex adaptive system, and efforts to improve through the implementation of best practice are well served by various interacting disciplines within the system. As a transdisciplinary model is new to clinicians, an infrastructure that creates academic-practice partnerships and builds capacity for scientific collaboration is necessary to test, spread, and implement improvement strategies. This paper describes the adoption of best practices from the science of team science in a healthcare improvement research network and the impact on conducting a large-scale network study. Key components of the research network infrastructure were mapped to a team science framework and evaluated in terms of their effectiveness and impact on a national study of nursing operations. Results from this study revealed an effective integration of the team science principles which facilitated the rapid collection of a large dataset. Implications of this study support a collaborative model for improvement research and stress a need for future research and funding to further evaluate the impact on dissemination and implementation. Frank Puga, Kathleen R. Stevens, and Darpan I. Patel Copyright © 2013 Frank Puga et al. All rights reserved. Wed, 13 Mar 2013 10:21:40 +0000 http://www.hindawi.com/journals/nrp/2013/374132/ The aim of this study is to establish structured clusters and well-defined ontological entities (nodes) describing ethical values as both ideal and opportunity for ethical manner as perceived by the caregiver. In this study, we use Bayesian Belief Networks (BBNs) to analyse ethical values (ethos) and ethical manners in daily work with older people. Material is based on questionnaire data collected by the instrument for the self-assessment of individual ethos in the care of older people (ISAEC) in spring 2007 in a municipality in Western Finland. This study is unique in its kind, both concerning the selected approach and methodological questions. BBNs have not been used significantly in nursing research, nor are there any studies that examine the ethical possibilities with focus on the probable effects upon changing conditions. Marianne Frilund, Lisbeth Fagerström, Katie Eriksson, and Patrik Eklund Copyright © 2013 Marianne Frilund et al. All rights reserved. Tue, 12 Mar 2013 15:44:45 +0000 http://www.hindawi.com/journals/nrp/2013/967084/ The purpose of this study was to describe nurses' experiences of their collaboration and relationships with family members in institutional respite care for the elderly. The family has a particularly important role in respite care, which is an extension of care provided at home. However no published studies were found on this subject. The data were collected through qualitative interviews (). Content analysis of the nurses’ descriptions of their collaboration with family members yielded four main categories as follows: (1) conscious ignoring, (2) attempting to understand the family’s situation, (3) hinting at private family matters, and (4) being a friend. The results lend support to earlier findings which emphasize the complexity of relationships between nurses and family carers. A novel finding here is that these relationships may also develop into friendships. Greater emphasis must be placed on primary nursing so that the nurse and informal carer can build up a genuine relationship of trust. If periods of respite care are to help older people and their families to manage independently, it is imperative that nurses have the opportunity to visit their patients at home. Sirpa Salin, Marja Kaunonen, and Päivi Åstedt-Kurki Copyright © 2013 Sirpa Salin et al. All rights reserved. Thu, 07 Mar 2013 11:02:08 +0000 http://www.hindawi.com/journals/nrp/2013/403717/ The aim of the study was to illuminate the meaning of older persons’ independent decision making concerning their daily care. Autonomy when in care is highly valued in the western world. However, research shows that autonomy can give rise to problematic issues. The complexity of independence and dependence for older people when living at home with help has also been highlighted. In Sweden, older people are increasingly expected to live at home with help from municipal home care services, and study into this aspect of care is limited. This study is a part of an ongoing project and has a qualitative life world perspective. Audiotaped narrative interviews were conducted and analysed using a phenomenological hermeneutic method. Findings revealed a main theme: “living with uncertainty as to how to relate one’s own independence and dependence with regard to oneself, and others.” This involves a constant process of relating to one’s independence controlled by others or oneself, and adjusting one’s independence and dependence with regard to oneself and others. The conclusion is that professional carers need to acknowledge the changing vulnerability of dependent older persons over time. The implication is a relational approach to autonomy beyond the traditional individualistic approach. Agneta Breitholtz, Ingrid Snellman, and Ingegerd Fagerberg Copyright © 2013 Agneta Breitholtz et al. All rights reserved. Thu, 21 Feb 2013 15:56:36 +0000 http://www.hindawi.com/journals/nrp/2013/304190/ Early detection of dysphagia is critical in stroke as it improves health care outcomes. Administering a swallowing screening tool (SST) in the emergency department (ED) appears most logical as it is the first point of patient contact. However, feasibility of an ED nurse-administered SST, particularly one involving trial water swallow administration, is unknown. The aims of this pilot study were to (1) implement an SST with a water swallow component in the ED and track nurses’ adherence, (2) identify barriers and facilitators to administering the SST through interviews, and (3) develop and implement a process improvement plan to address barriers. Two hundred seventy-eight individuals with stroke symptoms were screened from October 2009 to June 2010. The percentage of patients screened increased from 22.6 in October 2009 to a high of 80.8 in March 2010, followed by a decrease to 61.9% in June (Cochran-Armitage test ). The odds of being screened were 4.0 times higher after implementation compared to two months before implementation. Results suggest that it is feasible for ED nurses to administer an SST with a water swallow component. Findings should facilitate improved quality of care for patients with suspected stroke and improve multidisciplinary collaboration in swallowing screening. Stephanie K. Daniels, Jane A. Anderson, and Nancy J. Petersen Copyright © 2013 Stephanie K. Daniels et al. All rights reserved. Mon, 18 Feb 2013 08:13:11 +0000 http://www.hindawi.com/journals/nrp/2013/171872/ The study objective was to develop and evaluate a template for evidence-informed symptom protocols for use by nurses over the telephone for the assessment, triage, and management of patients experiencing cancer treatment-related symptoms. Guided by the CAN-IMPLEMENT© methodology, symptom protocols were developed by, conducting a systematic review of the literature to identify clinical practice guidelines and systematic reviews, appraising their quality, reaching consensus on the protocol template, and evaluating the two symptom protocols for acceptability and usability. After excluding one guideline due to poor overall quality, the symptom protocols were developed using 12 clinical practice guidelines (8 for diarrhea and 4 for fever). AGREE Instrument (Appraisal of Guidelines for Research and Evaluation) rigour domain subscale ratings ranged from 8% to 86% (median 60.1 diarrhea; 40.5 fever). Included guidelines were used to inform the protocols along with the Edmonton Symptom Assessment System questionnaire to assess symptom severity. Acceptability and usability testing of the symptom populated template with 12 practicing oncology nurses revealed high readability (), just the right amount of information (), appropriate terms (), fit with clinical work flow (), and being self-evident for how to complete (). Five nurses made suggestions and 11 rated patient self-management strategies the highest for usefulness. This new template for symptom protocols can be populated with symptom-specific evidence that nurses can use when assessing, triaging, documenting, and guiding patients to manage their-cancer treatment-related symptoms. Dawn Stacey, Gail Macartney, Meg Carley, Margaret B. Harrison, and The Pan-Canadian Oncology Symptom Triage and Remote Support Group (COSTaRS) Copyright © 2013 Dawn Stacey et al. All rights reserved. Tue, 12 Feb 2013 16:21:16 +0000 http://www.hindawi.com/journals/nrp/2013/794698/ Before 2005, time accrued on the lung transplant waiting list counted towards who was next in line for a donor lung. Then in 2005 the lung allocation scoring system was implemented, which meant the higher the illness severity scores, the higher the priority on the transplant list. Little is known of the lung transplant candidates who were listed before 2005 and were caught in the transition when the lung allocation scoring system was implemented. A narrative analysis was conducted to explore the illness narratives of seven lung transplant candidates between 2006 and 2007. Arthur Kleinman’s concept of illness narratives was used as a conceptual framework for this study to give voice to the illness narratives of lung transplant candidates. Results of this study illustrate that lung transplant candidates expressed a need to tell their personal story of waiting and to be heard. Recommendation from this study calls for healthcare providers to create the time to enable illness narratives of the suffering of waiting to be told. Narrative skills of listening to stories of emotional suffering would enhance how healthcare providers could attend to patients’ stories and hear what is most meaningful in their lives. Maria T. Yelle, Patricia E. Stevens, and Dorothy M. Lanuza Copyright © 2013 Maria T. Yelle et al. All rights reserved.