Nursing Research and Practice The latest articles from Hindawi Publishing Corporation © 2016 , Hindawi Publishing Corporation . All rights reserved. The NPs Role of Assessing and Intervening with Older Adult Drivers Sun, 23 Oct 2016 09:54:06 +0000 As the silver tsunami continues, assessing and intervening with older adult drivers are becoming an essential aspect of the comprehensive geriatric exam. The current lack of time efficient clinical guidelines is a concern and barrier for NPs. The purpose of this study was to identify strategies currently used by NPs. The critical incident technique was used to obtain data from a convenience sample of NPs. A total of 89 incidents were collected. The perspective of the NP can provide important information for developing clinical guidelines to promote individual and community safety. Tamatha Arms Copyright © 2016 Tamatha Arms. All rights reserved. Mentoring Nurses in Political Skill to Navigate Organizational Politics Thu, 29 Sep 2016 08:06:06 +0000 Objective. The aim of this study was to describe and analyze the correlations between mentoring functions and political skill development among nurses who have earned or are candidates for a Ph.D. or doctorate of nursing practice (DNP) degree. Background. The healthcare system is in flux; future generations of Ph.D. and DNP nurse leaders will be required to demonstrate political acumen. Political skill to navigate organizational politics has had limited research within nursing. Methods. A cross-sectional research design using a web-based survey of 222 nurses who have earned or are candidates for a Ph.D. or DNP. This study utilized two validated tools to measure mentoring functions and political skill. Results. The response rate was 52% () of which 86 were Ph.D. and 29 were DNPs. An informal mentoring relationship was described by 62% of the respondents and formal mentoring by 35% of the protégés; only 25% () established a mentoring contract. Mentoring score showed significance for total political skill and moderate effect on the networking ability. The mentoring functions of advocacy, career development facilitation, learning facilitation, and friendship were found to correlate significantly with total political skill scores. Conclusions. This study established a benefit for nurses who have earned or are candidates for a Ph.D. or DNP from mentoring to support political skill development. Wanda Montalvo and Mary W. Byrne Copyright © 2016 Wanda Montalvo and Mary W. Byrne. All rights reserved. Relatives to Critically Ill Patients Have No Sense of Coherence: A Quality Improvement Article Using Mixed Methods Thu, 15 Sep 2016 07:41:43 +0000 Aims and Objective. To investigate the relatives’ satisfaction and involvement on a general surgery ward regarding the critically ill patient. Introduction. Relatives to critically ill patients are affected both physically and mentally during the hospitalization of a family member. Research has shown that relatives do not always receive the attention they need from health professionals. There is a lack of studies that focus on relatives’ satisfaction and involvement during their family members’ hospitalization. Design. A mixed methods design was chosen. Methods. A quantitative study was conducted with 27 relatives to critically ill patients. All participated in a questionnaire and out of the 27 relatives, six participated in qualitative in-depth interviews. Results. The questionnaire revealed that relatives were dissatisfied with care and involvement. For further exploration of the dissatisfaction, a qualitative approach was used and the in-depth interviews revealed three themes: lack of continuity and structure, responsibility of coordination, and relatives feeling left on their own with no guiding and support. Conclusion. Health professionals’ key role in relation to relatives must be guidance and support. Thereby, relatives can gain a sense of coherence during the hospitalization of a critically ill patient, which can lead to a greater satisfaction and thereby better support for the patient. Jannie Laursen, Kristoffer Andresen, and Jacob Rosenberg Copyright © 2016 Jannie Laursen et al. All rights reserved. An Exploratory Study Using Cortisol to Describe the Response of Incarcerated Women IPV Survivors to MAMBRA Intervention Thu, 08 Sep 2016 14:35:19 +0000 Objective. To determine if incarcerated women survivors of IPV had a physiological response to the Music and Account-Making for Behavioral-Related Adaptation (MAMBRA) intervention, as measured by cortisol levels. Methods. A single-group repeated measures designed exploratory study was used to pilot-test MAMBRA. A convenience sample () was recruited in a Midwestern women’s correctional facility. Serving as their own control, participants provided demographics and pre-/post-MAMBRA salivary samples while attending four MAMBRA sessions. Baseline data were compared to participants’ data collected over the remaining 3 MAMBRA sessions. Data were analyzed with descriptive and univariate statistics with an alpha of .05 and post-hoc power of .65. Results. Participants were predominantly White (52%), single (80%), and early middle-aged (), with a history of physical/nonphysical spousal abuse. Using a subsample (), salivary cortisol decreased between the pre-/post-MAMBRA over the sessions (, ). Conclusion. Participants had a physiological response to the MAMBRA intervention as evidenced by the decreased cortisol between the pre-/post-MAMBRA. This is the first step in examining MAMBRA’s clinical utility as an intervention for female IPV survivors. Future longitudinal studies will examine MAMBRA’s effectiveness given this change in cortisol. Janette Y. Taylor and Ezra C. Holston Copyright © 2016 Janette Y. Taylor and Ezra C. Holston. All rights reserved. Eliciting Challenges on Social Connectedness among Filipino Nurse Returnees: A Cross-Sectional Mixed-Method Research Tue, 02 Aug 2016 05:56:21 +0000 This cross-sectional study utilized a nested concurrent design to determine the association of Filipino nurse returnees’ length of stay since they returned and their social connectedness as well as the essence of communication from their perspective. The respondents, who are Filipino nurses () who worked abroad and returned to the Philippines for good, were employed from June to July of 2015 via referrals from colleges and institutions in Metro Manila and Bulacan areas in the Philippines. The quantitative results revealed, in one hand, significant but weak correlation between the respondent’s length of stay and social connectedness (, , ). On the other hand, three themes were generated from the qualitative analysis, namely, (1) Taking-In, (2) Taking-Hold, and (3) Letting-Go. The Social Connection System (SCS) provides a visual depiction of the social connectedness of a person. This research is geared towards the understanding of the interesting phenomenon of migration and social coherence of Filipino professionals. Mary Jane L. Cortez, Christian V. Del Rosario, and Michael Joseph S. Diño Copyright © 2016 Mary Jane L. Cortez et al. All rights reserved. Experiences of African Students in Predominantly White Institutions: A Literature Overview Wed, 20 Jul 2016 16:48:24 +0000 The objective of this paper is to examine research conducted on the experiences of African health sciences students in predominantly white higher education institutions/environments. The main elements of cross-cultural adaptation models were adopted to discuss the amalgamated themes under the auspices of adjustment, integration, and conditioning. The overview revealed that African students encounter unique experiences, with isolation and “feeling different” being commonly mentioned. Recommendations for future research are presented, including programmatic implications for higher education and student affairs professionals. Davis Inyama, Allison Williams, and Kay McCauley Copyright © 2016 Davis Inyama et al. All rights reserved. Using Multidisciplinary Focus Groups to Inform the Development of mI SMART: A Nurse-Led Technology Intervention for Multiple Chronic Conditions Mon, 18 Jul 2016 14:07:37 +0000 Used as integrated tools, technology may improve the ability of healthcare providers to improve access and outcomes of care. Little is known about healthcare teams’ preferences in using such technology. This paper reports the findings from focus groups aimed at evaluating a newly developed primary care technology platform. Focus groups were completed in academic, outpatient, and community settings. Focus groups were attended by 37 individuals. The participants included professionals from multiple disciplines. Both prescribing () and nonprescribing healthcare team members () completed the focus groups and survey. The majority were practicing for more than 20 years (44.8%) in an outpatient clinic (62%) for 20–40 hours per week (37.9%). Providers identified perceived obstacles of patient use as ability, willingness, and time. System obstacles were identified as lack of integration, lack of reimbursement, and cost. The positive attributes of the developed system were capability for virtual visits, readability, connectivity, user-friendliness, ability to capture biophysical measures, enhanced patient access, and incorporation of multiple technologies. Providers suggested increasing capability for biophysical and symptom monitoring for more common chronic conditions. Technology interventions have the potential to improve access and outcomes but will not be successful without the input of users. Jennifer A. Mallow, Laurie A. Theeke, Elliott Theeke, and Brian K. Mallow Copyright © 2016 Jennifer A. Mallow et al. All rights reserved. Mind-Body Exercises for Nurses with Chronic Low Back Pain: An Evidence-Based Review Sun, 03 Jul 2016 11:51:42 +0000 Background. Chronic low back pain (CLBP) among nurses is a growing health concern. The multimodal nature of mind-body exercises has potential to impact physiological and psychological processes associated with chronic pain, affording possible advantages over conventional unimodal therapies. This paper summarizes the prevalence of and risk factors for CLBP among nurses, reviews the effectiveness in treating pain and disability of mind-body exercises (yoga and tai chi) for CLBP among the general and nursing population, and describes implications. Methods. Articles, published during or prior to 2015, were systematically identified through the PubMed/MEDLINE, Web of Science, and ScienceDirect databases using the following search terms: nurses, mind-body, integrative, biopsychosocial, yoga, tai chi, back pain, and/or risk factors. Results. Prevalence estimates of CLBP among nurses ranged from 50% to 80%. Associated risk factors for CLBP included lifestyle and physical, psychological, psychosocial, and occupational factors. No published studies were identified that evaluated yoga or tai chi for nurses with CLBP. Studies in the general population suggested that these interventions are effective in reducing pain and disability and may improve factors/processes predictive of CLBP. Conclusion. This review suggests that evaluating the impact of multimodal interventions such as yoga and tai chi for nurses with CLBP warrants investigation. Pinky Budhrani-Shani, Donna L. Berry, Patricia Arcari, Helene Langevin, and Peter M. Wayne Copyright © 2016 Pinky Budhrani-Shani et al. All rights reserved. Relationship-Building Skills of Child-Rearing Mothers in Japanese Communities Sun, 26 Jun 2016 10:49:19 +0000 This study elucidated the skills of mothers who used to build positive interpersonal relationships with people they met through child-rearing. The research method was qualitative descriptive study. The participants were 24 mothers who had children between ages of one and four years. These participants were recruited at child-rearing salons and childcare centers located in various municipalities in Japan. The survey period was from September 2013 to July 2014. The mothers’ interpersonal relationship-building skills were described by six categories: “ability to strive for new encounters,” “ability to try to interact socially with others,” “ability to choose compatible people,” “ability to continuously maintain good relationships,” “ability to take action suitable to a situation,” and “ability to build positive relationships with parents-in-law.” Cognitive aspects of assessing and understanding the interactions that occur during exchanges and behavioral aspects guided by these cognitions were identified within these skills. This study contributed to providing a framework to understand mothers’ interpersonal relationship-building skills for public health nurses involved in child-rearing support. Hikaru Honda, Nobuko Matsuda, Michiyo Hirano, and Kazuko Saeki Copyright © 2016 Hikaru Honda et al. All rights reserved. Improving Outcomes for Infants with Single Ventricle Physiology through Standardized Feeding during the Interstage Sun, 22 May 2016 09:52:50 +0000 Congenital heart disease is identified as the most common birth defect with single ventricle physiology carrying the highest mortality. Staged surgical palliation is required for treatment, with mortality historically as high as 22% in the four- to six-month period from the first- to second-stage surgical palliation, known as the interstage. A standardized postoperative feeding approach was implemented through an evidence-based protocol, parent engagement, and interprofessional team rounds. Five infants with single ventricle physiology preprotocol were compared with five infants who received the standardized feeding approach. Mann-Whitney tests were conducted to evaluate the hypotheses that infants in the intervention condition would consume more calories and have a positive change in weight-to-age -score (WAZ) and shorter length of stay (LOS) following the first and second surgeries compared to infants in the control condition. After the protocol, the change in WAZ during the interstage increased by virtually one standard deviation from 0.05 to 0.91. Median LOS dropped 32% after the first surgery and 43% after the second surgery. Since first- and second-stage palliative surgeries occur within the same year of life, this represents savings of 500,000 to 800,000 per year in a 10-infant model. The standardized feeding approach improved growth in single ventricle infants while concurrently lowering hospital costs. Cindy Weston, S. Adil Husain, Christopher L. Curzon, Steve Neish, Gemma T. Kennedy, Krista Bonagurio, and Kevin Gosselin Copyright © 2016 Cindy Weston et al. All rights reserved. Physiological Evaluation of Childcare-Associated Muscle Load on the Neck and Shoulder Region in Japanese Women Tue, 15 Mar 2016 16:28:27 +0000 The awkward movements and postures associated with childcare activities can lead to musculoskeletal symptoms in the neck and shoulders. “Dakko” is a method for carrying a child in Japan, and recently it has been reported to cause shoulder stiffness. To our knowledge, the relationship between childcare activities and the physical load on the neck and shoulders is poorly understood. The present study aims to clarify the muscle load on the neck and shoulder region through dakko simulations. First, the association between dakko movements and trapezius muscle activity is clarified by image and electromyogram analyses. Based on this clarification, the distributions and intensity of the muscle load from repetitive dakko movements are clarified using myogenic potential topography. During dakko movements, trapezius muscle activity was observed when lifting up and setting down the child, but not when holding the child. For the repetitive movements, myogenic electrical potentials were observed in the trapezius region after movement load, and individual characteristics of participants were revealed in both the load distributions and the recovery process. Repetitive dakko movements likely induced sustained muscle tonus in the trapezius, which may be a factor related to shoulder stiffness. Saori Yoshinaga, Takuma Kiyokawa, Eriko Kuramoto, Hiroe Kinoshita, and Seiji Nemoto Copyright © 2016 Saori Yoshinaga et al. All rights reserved. Recent Clinical Characteristics of Labors Using Three Japanese Systems of Midwife-Led Primary Delivery Care Mon, 29 Feb 2016 06:52:15 +0000 Objective. The objective of this study was to describe the recent clinical characteristics of labor using 3 systems of Japanese midwife-led primary delivery care, as follows: (1) those intending to give birth at home managed by midwives who do not belong to our hospital, (2) those planning to give birth in our hospital managed by the same midwives, and (3) those planning to give birth managed by midwives who belong to our hospital. Methods. A retrospective cohort study was performed. Results. There were no significant differences in the obstetric or neonatal outcomes among the 3 groups. The rate of transfers during labor with the system involving midwives belonging to our hospital was higher than those with the other 2 systems. In addition, the timing of transfers in the system with the midwives belonging to our hospital was earlier than with the other 2 systems. Among the 3 groups, there were no significant differences in the rate of the main 2 indications for transfers: fetal heart rate abnormality and failure to progress. Conclusion. There were no significant differences in perinatal outcomes among the 3 systems; however, there were some differences in the status of transfers to obstetric shared care. Shunji Suzuki Copyright © 2016 Shunji Suzuki. All rights reserved. Cognitive Behavioral Therapy in Psychiatric Nursing in Japan Sun, 20 Dec 2015 08:26:16 +0000 Psychiatric nurses have played a significant role in disseminating cognitive behavioral therapy (CBT) in Western countries; however, in Japan, the application, practice, efficiency, and quality control of CBT in the psychiatric nursing field are unclear. This study conducted a literature review to assess the current status of CBT practice and research in psychiatric nursing in Japan. Three English databases (MEDLINE, CINAHL, and PsycINFO) and two Japanese databases (Ichushi-Web and CiNii) were searched with predetermined keywords. Fifty-five articles met eligibility criteria: 46 case studies and 9 comparative studies. It was found that CBT took place primarily in inpatient settings and targeted schizophrenia and mood disorders. Although there were only a few comparative studies, each concluded that CBT was effective. However, CBT recipients and outcome measures were diverse, and nurses were not the only CBT practitioners in most reports. Only a few articles included the description of CBT training and supervision. This literature review clarified the current status of CBT in psychiatric nursing in Japan and identified important implications for future practice and research: performing CBT in a variety of settings and for a wide range of psychiatric disorders, conducting randomized controlled trials, and establishing pre- and postqualification training system. Naoki Yoshinaga, Akiko Nosaki, Yuta Hayashi, Hiroki Tanoue, Eiji Shimizu, Hiroko Kunikata, Yoshie Okada, and Yuko Shiraishi Copyright © 2015 Naoki Yoshinaga et al. All rights reserved. The Significance of Asthma Follow-Up Consultations for Adherence to Asthma Medication, Asthma Medication Beliefs, and Asthma Control Mon, 07 Dec 2015 11:15:11 +0000 Objective. The aim was to investigate adherence to asthma medication treatment, medication beliefs, and asthma control in relation to asthma follow-up consultations in asthmatics in the general population. A further aim was to describe associations between adherence, medication beliefs, and asthma control. Method. In the population-based West Sweden Asthma Study, data allowing calculation of adherence for 4.5 years based on pharmacy records were obtained from 165 adult asthmatics. Additional data were collected through questionnaires and structured interviews. Results. The mean adherence value for filled prescriptions for regular asthma medication was 68% (median 55.3%) but varied over the year under study. Adherence to combination inhalers with corticosteroids and long-acting beta2 agonists was higher than adherence to single inhalers with corticosteroids only. More than one-third of participants reported not having seen an asthma nurse or physician for several years. Regular asthma follow-up consultations were associated with both higher adherence and the belief that asthma medication was necessary but were not associated with asthma control. Conclusions. Adherence to asthma medication treatment was low and varied over the year under study. The current study suggests that quality improvements in asthma care are needed if adherence to asthma medication is to be improved. Malin Axelsson, Linda Ekerljung, and Bo Lundbäck Copyright © 2015 Malin Axelsson et al. All rights reserved. Effectiveness of Facebook-Delivered Lifestyle Counselling and Physical Activity Self-Monitoring on Physical Activity and Body Mass Index in Overweight and Obese Adolescents: A Randomized Controlled Trial Tue, 01 Dec 2015 14:32:02 +0000 Background. The aim was to evaluate the effects of a 12-week, Facebook-delivered lifestyle counselling intervention, with or without physical activity self-monitoring, on physical activity and body mass index (BMI) in overweight and obese 13–16-year-old adolescents. Methods. Three-arm randomized controlled trial. Participants () were randomly assigned to intervention and control groups: one group received Facebook-delivered lifestyle counselling and monitoring of their physical activity (Fb + Act, ), whereas a second experimental group received the same Facebook-delivered lifestyle counselling without self-monitoring (Fb, ) and a third group served as the control group (). Objective and self-reported physical activity assessment were used. Nonparametric statistical tests were used. Results. There were no significant intervention effects in terms of changes in physical activity levels or BMI from baseline to the 12-week postintervention measurements between the intervention and control groups. The Fb + Act group had lower sedentary time on weekdays compared to the control group during postintervention measurements (), but there was no interaction between time and group. Conclusions. Interventions were not effective at increasing physical activity in overweight and obese adolescents. Before implementing such interventions, more evaluations on their effectiveness are needed. This trial is registered with identifier NCT02295761 (2014-11-17). Heidi Ruotsalainen, Helvi Kyngäs, Tuija Tammelin, Hanna Heikkinen, and Maria Kääriäinen Copyright © 2015 Heidi Ruotsalainen et al. All rights reserved. Spousal Presence as a Nonpharmacological Pain Management during Childbirth: A Pilot Study Sun, 22 Nov 2015 08:44:24 +0000 Background. Measures of spousal effect during parturient pain should take a tripartite approach involving the parturients, spouses, and midwives. Aim. To develop and validate three questionnaires measuring spousal presence in management of parturient pain in Nigeria. Methods. There are two phases: (1) development of questionnaires, Abuja Instrument for Midwives (AIM), Abuja Instrument for Parturient Pain (AIPP), and Abuja Instrument for Parturient Spouses (AIPS), utilizing literatures, Kuopio instrument for fathers (KIF) and expertise of health professionals, and (2) pilot study to validate the questionnaires which were administered in two hospitals in Nigeria: midwives , parturients , and spouses .  Results. Internal consistency for the three questionnaires indicated Cronbach’s alpha coefficient of 0.789 (AIM), 0.802 (AIPP), and 0.860 (AIPS), while test-retest reliability was (AIM), (AIPP), and (AIPS). Conclusions. AIM, AIPP, and AIPS provide a means of investigating the effectiveness of spousal presence in management of parturient pain in Nigeria. However, further testing of each instrument is needed in a larger population to replicate the beneficial findings of AIMS, AIPP, and AIPS which can contribute rigor to future studies. Abigail U. Emelonye, Taina Pitkäaho, and Katri Vehviläinen-Julkunen Copyright © 2015 Abigail U. Emelonye et al. All rights reserved. Symptomatology and Coping Resources Predict Self-Care Behaviors in Middle to Older Age Patients with Heart Failure Thu, 05 Nov 2015 14:16:20 +0000 Background. Symptoms of heart failure (HF) and coping resources, such as social support and social problem-solving, may influence self-care behaviors. Research regarding the influence of HF symptomatology characteristics and components of social support and social problem-solving on self-care is limited. Objective. To identify predictors of HF self-care behaviors using characteristics of HF symptomatology, components of social support and social problem-solving, and demographic and clinical factors. Methods. Using a cross-sectional, correlational predictive design, a convenience sample () of outpatients with HF answered self-report surveys. Multiple linear regression with stepwise variable selection was conducted. Results. Six predictors of HF self-care were identified: race, symptom frequency, symptom-related interference with enjoyment of life, New York Heart Association Class HF, rational problem-solving style, and social network (, , ). Conclusions. Assessing the influence of race on self-care behaviors in middle to older age patients with HF is important. Clinical assessment that focuses on symptom frequency, symptom-related interference with enjoyment of life, and HF Class might also impact self-care behaviors in this population. Rational problem-solving skills used and evaluation of the size of and satisfaction with one’s social network may be appropriate when assessing self-care. Lucinda J. Graven, Joan S. Grant, and Glenna Gordon Copyright © 2015 Lucinda J. Graven et al. All rights reserved. Nurses’ and Nursing Students’ Knowledge and Attitudes regarding Pediatric Pain Mon, 12 Oct 2015 07:26:29 +0000 Nursing staff spend more time with patients with pain than any other health staff member. For this reason, the nurse must possess the basic knowledge to identify the presence of pain in patients, to measure its intensity and make the steps necessary for treatment. Therefore, a prospective, descriptive, analytical, and cross-sectional study was conducted to investigate the knowledge and attitudes regarding pediatric pain in two different populations. The questionnaire, Pediatric Nurses Knowledge and Attitudes Survey Regarding Pain (PKNAS), was applied to 111 hospital pediatric nurses and 300 university nursing students. The final scores for pediatric nurses and nursing students were 40.1 ± 7.9 and 40.3 ± 7.5, respectively. None of the sociodemographic variables predicted the scores obtained by the participants (). There was a high correlation between the PKNAS scores of pediatric nurses and nursing students (, ). It was observed that the degree of knowledge about pain and its treatment was very low in both groups. Due to this deficiency, pain in children remains inadequately managed, which leads to suffering in this population. It is necessary to increase the continued training in this subject in both areas. Mario I. Ortiz, Héctor A. Ponce-Monter, Eduardo Rangel-Flores, Blanca Castro-Gamez, Luis C. Romero-Quezada, Jessica P. O’Brien, Georgina Romo-Hernández, and Marco A. Escamilla-Acosta Copyright © 2015 Mario I. Ortiz et al. All rights reserved. Previous Education, Sociodemographic Characteristics, and Nursing Cumulative Grade Point Average as Predictors of Success in Nursing Licensure Examinations Thu, 08 Oct 2015 13:47:28 +0000 Introduction. Success in the licensure examination is the only legal prerequisite to practice as a nurse in Ghana. However, a large percentage of nursing students who sit fail this examination for the first time. This study sought to unravel whether prior education, sociodemographic characteristics, and nursing Cumulative Grade Point Average (CGPA) could predict performance in the licensure examinations. Methods. The study was a descriptive cross-sectional survey conducted from November 2014 to April 2015 in the Kumasi metropolis, Ghana on 176 past nursing students. Data was collected using questionnaires and analyzed using SPSS version 22. A logistic regression model was fitted to look at the influence of the explanatory variables on the odds of passing the licensure examinations. All statistical significances were tested at p value of <0.05. Results. Majority, 56.3%, were females and 86.4% were between the ages of 25 and 31 years. Most of the students (88.6%) entered the nursing training colleges with a WASSCE qualification and 38% read general science. 73.9% passed the licensure examinations and the mean CGPA of the students was 2.89 . Sociodemographic characteristics and previous education had no influence on performance in the licensure examinations. CGPA had strong positive relationship with performance in licensure examinations (AOR = 15.27; 95% CI = 6.28, 27.11). Conclusion. Students CGPA could be a good predictor of their performance in the licensure examinations. On the other hand, students’ sociodemographic and previous educational characteristics might not be important factors to consider in admitting students into the nursing training programme. Isaac Amankwaa, Anabella Agyemang-Dankwah, and Daniel Boateng Copyright © 2015 Isaac Amankwaa et al. All rights reserved. Engaging with Families Is a Challenge: Beliefs among Healthcare Professionals in Forensic Psychiatric Care Thu, 10 Sep 2015 14:06:01 +0000 Being healthcare professionals in the complex field of forensic psychiatry care (FPC) seems particularly challenging. Historically, families have almost been invisible in FPC. The aim of this study was to uncover beliefs among healthcare professionals concerning families of patients admitted for FPC. Using a hermeneutical approach inspired by Gadamer’s philosophy, group interviews with healthcare professionals in four Swedish forensic psychiatric clinics were analyzed. Analysis resulted in seven key beliefs. There were three beliefs about families: family belongingness is a resource for the patient; most families are broken and not possible to trust; and most families get in the way of the patient’s care. Four beliefs concerned encounters with families: it is important to achieve a balance and control over the family; it is essential to set aside one’s own values and morals; family-oriented work is an impossible mission; and family oriented work requires welcoming the families. Despite ethical dilemmas of working with families in FPC, healthcare professionals showed a willingness and desire to work in a more family-oriented manner. More knowledge, understanding, and caring tools are needed in order to meet the needs of the family as well as support the family’s resources. Ulrica Hörberg, Eva Benzein, Christen Erlingsson, and Susanne Syrén Copyright © 2015 Ulrica Hörberg et al. All rights reserved. Indicators for Evaluating the Performance and Quality of Care of Ambulatory Care Nurses Mon, 24 Aug 2015 09:08:44 +0000 The quality and safety of nursing care vary from one service to another. We have only very limited information on the quality and safety of nursing care in outpatient settings, an expanding area of practice. Our aim in this study was to make available, from the scientific literature, indicators potentially sensitive to nursing that can be used to evaluate the performance of nursing care in outpatient settings and to integrate those indicators into the theoretical framework of Dubois et al. (2013). We conducted a scoping review in three databases (CINAHL, MEDLINE, and EMBASE) and the bibliographies of selected articles. From a total of 116 articles, we selected 22. The results of our study not only enable that framework to be extended to ambulatory nursing care but also enhance it with the addition of five new indicators. Our work offers nurses and managers in ambulatory nursing units indicators potentially sensitive to nursing that can be used to evaluate performance. For researchers, it presents the current state of knowledge on this construct and a framework with theoretical foundations for future research in ambulatory settings. This work opens an unexplored field for further research. Joachim Rapin, Danielle D’Amour, and Carl-Ardy Dubois Copyright © 2015 Joachim Rapin et al. All rights reserved. Job Satisfaction among Care Aides in Residential Long-Term Care: A Systematic Review of Contributing Factors, Both Individual and Organizational Wed, 05 Aug 2015 06:31:25 +0000 Despite an increasing literature on professional nurses’ job satisfaction, job satisfaction by nonprofessional nursing care providers and, in particular, in residential long-term care facilities, is sparsely described. The purpose of this study was to systematically review the evidence on which factors (individual and organizational) are associated with job satisfaction among care aides, nurse aides, and nursing assistants, who provide the majority of direct resident care, in residential long-term care facilities. Nine online databases were searched. Two authors independently screened, and extracted data and assessed the included publications for methodological quality. Decision rules were developed a priori to draw conclusions on which factors are important to care aide job satisfaction. Forty-two publications were included. Individual factors found to be important were empowerment and autonomy. Six additional individual factors were found to be not important: age, ethnicity, gender, education level, attending specialized training, and years of experience. Organizational factors found to be important were facility resources and workload. Two additional factors were found to be not important: satisfaction with salary/benefits and job performance. Factors important to care aide job satisfaction differ from those reported among hospital nurses, supporting the need for different strategies to improve care aide job satisfaction in residential long-term care. Janet E. Squires, Matthias Hoben, Stefanie Linklater, Heather L. Carleton, Nicole Graham, and Carole A. Estabrooks Copyright © 2015 Janet E. Squires et al. All rights reserved. Social Interaction and Collaboration among Oncology Nurses Sun, 31 May 2015 08:04:26 +0000 Collaboration is a complex process influenced by organizational, professional, interpersonal, and personal factors. Research has demonstrated that collaboration may also be influenced by social factors. Nurses spend much of their time working in collaborative teams, yet little is known about how they socially interact in practice. This qualitative case study explored nurse perceptions of social interaction in relation to collaboration. Data were collected using telephone interviews and documentary reviews from fourteen oncology nurses employed at one cancer center in Canada. Thematic analysis revealed two themes: knowing you is trusting you and formal and informal opportunities. Nurses reported that social interaction meant getting to know someone personally as well as professionally. Social interaction was enacted inside of work during breaks/meals and outside of work at planned events. Social interaction was facilitated by having a long-term current and/or previous professional and personal relationship. The barriers to social interaction included a lack of time to get to know each other, workload issues, and poor interpersonal skills. Findings suggest that social interaction is an important factor in the collaborative relationship among oncology nurses. Nurse leaders need to promote social interaction opportunities and facilitate educational sessions to improve social and interpersonal skills. Jane Moore, Dawn Prentice, and Maurene McQuestion Copyright © 2015 Jane Moore et al. All rights reserved. Postinfusion Phlebitis: Incidence and Risk Factors Thu, 14 May 2015 13:57:25 +0000 Objective. To document the incidence of postinfusion phlebitis and to investigate associated risk factors. Design. Analysis of existing data set from a large randomized controlled trial, the primary purpose of which was to compare routine peripheral intravascular catheter changes with changing catheters only on clinical indication. Participants and Setting. Patients admitted to a large, acute general hospital in Queensland, Australia, and who required a peripheral intravenous catheter. Results. 5,907 PIVCs from 3,283 patients were studied. Postinfusion phlebitis at 48 hours was diagnosed in 59 (1.8%) patients. Fifteen (25.4%) of these patients had phlebitis at removal and also at 48 hours after removal. When data were analyzed per catheter, the rate was lower, 62/5907 (1.1%). The only variable associated with postinfusion phlebitis was placement of the catheter in the emergency room . Conclusion. Although not a common occurrence, postinfusion phlebitis may be problematic so it is important for health care staff to provide patients with information about what to look for after an intravascular device has been removed. This trial is registered with ACTRN12608000445370. Joan Webster, Matthew McGrail, Nicole Marsh, Marianne C. Wallis, Gillian Ray-Barruel, and Claire M. Rickard Copyright © 2015 Joan Webster et al. All rights reserved. Flushing and Locking of Venous Catheters: Available Evidence and Evidence Deficit Thu, 14 May 2015 11:50:26 +0000 Flushing and locking of intravenous catheters are thought to be essential in the prevention of occlusion. The clinical sign of an occlusion is catheter malfunction and flushing is strongly recommended to ensure a well-functioning catheter. Therefore fluid dynamics, flushing techniques, and sufficient flushing volumes are important matters in adequate flushing in all catheter types. If a catheter is not in use, it is locked. For years, it has been thought that the catheter has to be filled with an anticoagulant to prevent catheter occlusion. Heparin has played a key role in locking venous catheters. However, the high number of risks associated with heparin forces us to look for alternatives. A long time ago, 0.9% sodium chloride was already introduced as locking solution in peripheral cannulas. More recently, a 0.9% sodium chloride lock has also been investigated in other types of catheters. Thrombolytic agents have also been studied as a locking solution because their antithrombotic effect was suggested as superior to heparin. Other catheter lock solutions focus on the anti-infective properties of the locks such as antibiotics and chelating agents. Still, the most effective locking solution will depend on the catheter type and the patient’s condition. Godelieve Alice Goossens Copyright © 2015 Godelieve Alice Goossens. All rights reserved. Disinfection of Needleless Connector Hubs: Clinical Evidence Systematic Review Thu, 14 May 2015 11:36:10 +0000 Background. Needleless connectors (NC) are used on virtually all intravascular devices, providing an easy access point for infusion connection. Colonization of NC is considered the cause of 50% of postinsertion catheter-related infections. Breaks in aseptic technique, from failure to disinfect, result in contamination and subsequent biofilm formation within NC and catheters increasing the potential for infection of central and peripheral catheters. Methods. This systematic review evaluated 140 studies and 34 abstracts on NC disinfection practices, the impact of hub contamination on infection, and measures of education and compliance. Results. The greatest risk for contamination of the catheter after insertion is the NC with 33–45% contaminated, and compliance with disinfection as low as 10%. The optimal technique or disinfection time has not been identified, although scrubbing with 70% alcohol for 5–60 seconds is recommended. Studies have reported statistically significant results in infection reduction when passive alcohol disinfection caps are used (48–86% reduction). Clinical Implications. It is critical for healthcare facilities and clinicians to take responsibility for compliance with basic principles of asepsis compliance, to involve frontline staff in strategies, to facilitate education that promotes understanding of the consequences of failure, and to comply with the standard of care for hub disinfection. Nancy L. Moureau and Julie Flynn Copyright © 2015 Nancy L. Moureau and Julie Flynn. All rights reserved. Implementation of Free Text Format Nursing Diagnoses at a University Hospital’s Medical Department. Exploring Nurses’ and Nursing Students’ Experiences on Use and Usefulness. A Qualitative Study Wed, 13 May 2015 11:27:58 +0000 Background. Nursing documentation has long traditions and represents core element of nursing, but the documentation is often criticized of being incomplete. Nursing diagnoses are an important research topic in nursing in terms of quality of nursing assessment, interventions, and outcome in addition to facilitating communication and continuity. Aim. The aim of this study was to explore the nurses’ and nursing students’ experiences after implementing free text format nursing diagnoses in a medical department. Method. The study design included educational intervention of free text nursing diagnoses. Data was collected through five focus group interviews with 18 nurses and 6 students as informants. The data was analyzed using qualitative content analysis. Results. The informants describe positive experiences concerning free text format nursing diagnoses’ use and usefulness; it promotes reflection and discussion and is described as a useful tool in the diagnostic process, though it was challenging to find the diagnosis’ appropriate formulation. Conclusion. Our findings indicate a valid usability of free text format nursing diagnoses as it promotes the diagnostic process. The use seems to enhance critical thinking and may serve as valuable preparation towards an implementation of standardized nursing diagnoses. Use and support of key personnel seem valuable in an implementation process. Sigrun Aasen Frigstad, Torunn Hatlen Nøst, and Beate André Copyright © 2015 Sigrun Aasen Frigstad et al. All rights reserved. Sexual Abuse of Older Residents in Nursing Homes: A Focus Group Interview of Nursing Home Staff Mon, 11 May 2015 08:16:07 +0000 The objective of this study was to increase knowledge of sexual abuse against older residents in nursing homes. A qualitative approach was used. Through a focus group interview with staff in nursing homes, the aim was to reveal employees’ thoughts, experiences, and attitudes. Findings from the focus group interview show that sexual abuse of older residents is a taboo topic among health professionals. Acts of sexual abuse are difficult to imagine; it is hard to believe that it occurs. The fact that staff are not aware that it could happen, or have a hard time believing that it actually happens, can amplify the residents’ vulnerable position as potential victims of abuse, and it makes it even more challenging to report or uncover such acts. The study highlights the need for education of all health care workers in Norway as well as more research on sexual abuse against older residents in nursing homes. Furthermore, there is a need for good policies and reporting systems, as an important step towards addressing sexual abuse of the aged in a more appropriate way. Further research must aim to reveal more about this taboo area. Maria Helen Iversen, Astrid Kilvik, and Wenche Malmedal Copyright © 2015 Maria Helen Iversen et al. All rights reserved. Effect of Four Approaches to Oral Feeding Progression on Clinical Outcomes in Preterm Infants Mon, 27 Apr 2015 08:51:05 +0000 Background. The purpose of this study of preterm infants was to test the effect of four approaches to the time of transition from gavage to full oral feedings, time to discharge, and weight gain during the transition. Methods. A randomized experimental design was used with four intervention groups: early start (32 weeks’ postmenstrual age)/slow progressing experience (gradually increasing oral feedings offered per day); early start/maximum experience (oral feedings offered at every feeding opportunity); late start (34 weeks’ postmenstrual age)/slow progressing experience; and late start/maximum experience. Results. The analysis included 86 preterm infants. Once oral feedings were initiated, infants in the late start/maximum experience group achieved full oral feeding and were discharged to home significantly sooner than infants in either early start group. Although not significantly different, these infants also achieved these outcomes sooner than infants in the late start/slow progressing experience group. There were no differences in weight gain across groups. Conclusions. Results suggest starting oral feedings later in preterm infants may result in more rapid transition to full oral feedings and discharge although not at early postnatal ages. Provision of a more consistent approach to oral feeding may support infant neurodevelopment and reduce length of hospitalization. Rita H. Pickler, Barbara A. Reyna, Paul A. Wetzel, and Mary Lewis Copyright © 2015 Rita H. Pickler et al. All rights reserved. Biofeedback Intervention for Stress, Anxiety, and Depression among Graduate Students in Public Health Nursing Tue, 14 Apr 2015 07:56:39 +0000 Globally, graduate students have been found to have high prevalence of mental health problems. With increasing severity of mental health problems on university campuses and limited resources for mental health treatment, alternative interventions are needed. This study investigated the use of biofeedback training to help reduce symptoms of stress, anxiety, and depression. A sample of 60 graduate students in public health nursing was randomly assigned to either the biofeedback intervention or the control group. Results indicated that biofeedback intervention was effective in significantly reducing the levels of stress, anxiety, and depression over the 4-week period, while the control group had increases in symptoms of anxiety and depression over the same timeframe. As future leaders in the public health nursing arena, the more psychologically healthy the graduate students in public health nursing are, the better the public health nursing professionals they will be as they go forth to serve the community after graduation. Paul Ratanasiripong, Orawan Kaewboonchoo, Nop Ratanasiripong, Suda Hanklang, and Pornlert Chumchai Copyright © 2015 Paul Ratanasiripong et al. All rights reserved.