Twitter as a Tool for Health Research: A Systematic Review.
Am J Public Health. 2017 Jan;107(1):e1-e8
Authors: Sinnenberg L, Buttenheim AM, Padrez K, Mancheno C, Ungar L, Merchant RM
BACKGROUND: Researchers have used traditional databases to study public health for decades. Less is known about the use of social media data sources, such as Twitter, for this purpose.
OBJECTIVES: To systematically review the use of Twitter in health research, define a taxonomy to describe Twitter use, and characterize the current state of Twitter in health research.
SEARCH METHODS: We performed a literature search in PubMed, Embase, Web of Science, Google Scholar, and CINAHL through September 2015.
SELECTION CRITERIA: We searched for peer-reviewed original research studies that primarily used Twitter for health research.
DATA COLLECTION AND ANALYSIS: Two authors independently screened studies and abstracted data related to the approach to analysis of Twitter data, methodology used to study Twitter, and current state of Twitter research by evaluating time of publication, research topic, discussion of ethical concerns, and study funding source.
MAIN RESULTS: Of 1110 unique health-related articles mentioning Twitter, 137 met eligibility criteria. The primary approaches for using Twitter in health research that constitute a new taxonomy were content analysis (56%; n = 77), surveillance (26%; n = 36), engagement (14%; n = 19), recruitment (7%; n = 9), intervention (7%; n = 9), and network analysis (4%; n = 5). These studies collectively analyzed more than 5 billion tweets primarily by using the Twitter application program interface. Of 38 potential data features describing tweets and Twitter users, 23 were reported in fewer than 4% of the articles. The Twitter-based studies in this review focused on a small subset of data elements including content analysis, geotags, and language. Most studies were published recently (33% in 2015). Public health (23%; n = 31) and infectious disease (20%; n = 28) were the research fields most commonly represented in the included studies. Approximately one third of the studies mentioned ethical board approval in their articles. Primary funding sources included federal (63%), university (13%), and foundation (6%).
CONCLUSIONS: We identified a new taxonomy to describe Twitter use in health research with 6 categories. Many data elements discernible from a user's Twitter profile, especially demographics, have been underreported in the literature and can provide new opportunities to characterize the users whose data are analyzed in these studies. Twitter-based health research is a growing field funded by a diversity of organizations. Public health implications. Future work should develop standardized reporting guidelines for health researchers who use Twitter and policies that address privacy and ethical concerns in social media research.
PMID: 27854532 [PubMed - indexed for MEDLINE]
How are we assessing near-peer teaching in undergraduate health professional education? A systematic review.
Nurse Educ Today. 2017 Mar;50:42-50
Authors: Irvine S, Williams B, McKenna L
BACKGROUND: Near Peer teaching (NPT) is reported as an effective pedagogical approach to student learning and performance. Studies in medicine, nursing and health sciences have relied mainly on self-reports to describe its benefits, focusing on psychomotor and cognitive aspects of learning. Despite increasing research reports on peer teaching internationally, little is known about the various domains of learning used in assessment of performance and objective learning outcomes of NPT.
OBJECTIVE: To determine the domains of learning and assessment outcomes used in NPT in undergraduate health professional education.
METHODS: Quantitative systematic review was conducted in accord with the PRISMA protocol and the Joanna Briggs Institute processes. A wide literature search was conducted for the period 1990-November 2015 of fourteen databases. Grey literature was undertaken from all key research articles. Studies meeting the inclusion criteria were eligible for consideration, including measured learning outcomes of near-peer teaching in undergraduate education in nursing, medicine and health sciences. Set limitations included publications after 1990 (2015 inclusive), English language and objective learning outcomes. A quality appraisal process involving two independent reviewers was used to analyse the data.
RESULTS: Of 212 selected articles, 26 were included in the review. Terminology was confusing and found to be a barrier to the review process. Although some studies demonstrated effective learning outcomes resulting from near-peer teaching, others were inconclusive. Studies focused on cognitive and psychomotor abilities of learners with none assessing metacognition, affective behaviours or learning outcomes from quality of understanding.
CONCLUSION: The studies reviewed focused on cognitive and psychomotor abilities of learners. Even though evidence clearly indicates that metacognition and affective behaviours have direct influence on learning and performance, indicating more research around this topic is warranted. Methodological quality of the studies and lack of theoretical frameworks underpinned by educational psychology may have contributed to inconsistencies in learning outcomes reported.
PMID: 28012361 [PubMed - indexed for MEDLINE]
Mentoring: Positively Influencing Job Satisfaction and Retention of New Hire Nurse Practitioners.
Plast Surg Nurs. 2017 Jan/Mar;37(1):7-22
Authors: Horner DK
The purpose of study was to determine whether mentoring based on Watson's Caring Model positively influences nurse practitioner (NP) job satisfaction. This nonexperimental mixed-methods study utilized an online survey, administered through Qualtrics containing demographic and mentoring variables. Job satisfaction results were obtained from the Misener Nurse Practitioner Job Satisfaction Scale (MNPJSS). Also, open-ended questions regarding mentoring were reported. There was a 54% response rate in which 37 of the 69 participants responded (n = 37), with statistical significance set at p < .05. All or 100% of participants reported that the mentor experience/relationship positively influenced job satisfaction. Scores from the MNPJSS ranged from 141 to 246, with a mean of 195.26 (SD = 28.29) corresponding to "minimally satisfied" or a mean of 4.44 on the 6-point scale. These results are similar to the MNPJSS score with a mean of 4.39. A mentoring experience can provide a positive environment, which can lead to increased job satisfaction. In turn, a higher level of satisfaction in the work environment can be associated with reduced turnover and improved retention and patient outcomes. Ultimately, a safer health care system will evolve and improve patient care and outcomes. Through Watson's Caring Model, a reciprocal relationship between the mentor and the mentee can provide a new NP hire a sense of community and direct availability. By experiencing a mentor relationship, job satisfaction can improve, which is a key factor in retaining NPs. As E-mentoring is a newer topic in nursing literature, further research is needed. Further studies could also review and develop one-on-one mentoring programs.
PMID: 28244960 [PubMed - indexed for MEDLINE]
Emotional intelligence increases over time: A longitudinal study of Australian pre-registration nursing students.
Nurse Educ Today. 2017 May 15;55:65-70
Authors: Foster K, Fethney J, McKenzie H, Fisher M, Harkness E, Kozlowski D
BACKGROUND: Emotional intelligence (EI) has been associated with positive outcomes for nursing students. Higher EI is associated with personal wellbeing and stress management, higher academic performance, stronger nursing leadership and practice performance, and greater patient safety. While there is an increasing body of evidence on nursing students' EI, there is minimal evidence on EI over time during pre-registration programs.
OBJECTIVES: To measure EI in pre-registration nursing students from program commencement to conclusion to ascertain EI over time and examine the relationship between EI and academic performance.
DESIGN AND SETTING: Longitudinal repeated measures study between March 2010-February 2013 at a metropolitan university in Australia.
PARTICIPANTS: 111 nursing students (74.8% female) contributed data on at least two occasions. Participants were enrolled in a pre-registration Master of Nursing degree. Half the cohort (55.0%) comprised Graduate Entry students who completed the course in two years full time. The other 45% were enrolled in an undergraduate degree in arts, science or health science, combined with the same pre-registration Master of Nursing Degree. These students completed their Combined Degree program in four years full time. Participants had a mean age of 24.7years (SD=7.36).
METHODS: EI was measured for commencing students (T1) using the Assessing Emotions Scale (AES), then a further three times: end of first year (T2; 9 months follow up); beginning of second year (12 months follow up; T3) and end of the program (T4; 24/36 months follow up).
RESULTS: Students' EI was found to increase across the program; one subscale of EI (managing others' emotions) was related to higher academic performance; and there was a significant increase in the Utilising Emotions subscale scores over time.
CONCLUSIONS: Pre-registration nurse education contributes to strengthening students' EI over time. Specific EI education scaffolded throughout programs is recommended in pre-registration curricula.
PMID: 28528126 [PubMed - as supplied by publisher]
Clinical productivity of primary care nurse practitioners in ambulatory settings.
Nurs Outlook. 2017 Mar - Apr;65(2):162-171
Authors: Xue Y, Tuttle J
BACKGROUND: Nurse practitioners are increasingly being integrated into primary care delivery to help meet the growing demand for primary care. It is therefore important to understand nurse practitioners' productivity in primary care practice.
PURPOSE: We examined nurse practitioners' clinical productivity in regard to number of patients seen per week, whether they had a patient panel, and patient panel size. We further investigated practice characteristics associated with their clinical productivity.
METHODS: We conducted cross-sectional analysis of the 2012 National Sample Survey of Nurse Practitioners. The sample included full-time primary care nurse practitioners in ambulatory settings. Multivariable survey regression analyses were performed to examine the relationship between practice characteristics and nurse practitioners' clinical productivity.
RESULTS: Primary care nurse practitioners in ambulatory settings saw an average of 80 patients per week (95% confidence interval [CI]: 79-82), and 64% of them had their own patient panel. The average patient panel size was 567 (95% CI: 522-612). Nurse practitioners who had their own patient panel spent a similar percent of time on patient care and documentation as those who did not. However, those with a patient panel were more likely to provide a range of clinical services to most patients. Nurse practitioners' clinical productivity was associated with several modifiable practice characteristics such as practice autonomy and billing and payment policies.
DISCUSSIONS: The estimated number of patients seen in a typical week by nurse practitioners is comparable to that by primary care physicians reported in the literature. However, they had a significantly smaller patient panel. Nurse practitioners' clinical productivity can be further improved.
PMID: 27773346 [PubMed - indexed for MEDLINE]
The Effects of Pay-for-Performance Programs on Health, Health Care Use, and Processes of Care: A Systematic Review.
Ann Intern Med. 2017 Mar 07;166(5):341-353
Authors: Mendelson A, Kondo K, Damberg C, Low A, Motúapuaka M, Freeman M, O'Neil M, Relevo R, Kansagara D
Background: The benefits of pay-for-performance (P4P) programs are uncertain.
Purpose: To update and expand a prior review examining the effects of P4P programs targeted at the physician, group, managerial, or institutional level on process-of-care and patient outcomes in ambulatory and inpatient settings.
Data Sources: PubMed from June 2007 to October 2016; MEDLINE, PsycINFO, CINAHL, Business Economics and Theory, Business Source Elite, Scopus, Faculty of 1000, and Gartner Research from June 2007 to February 2016.
Study Selection: Trials and observational studies in ambulatory and inpatient settings reporting process-of-care, health, or utilization outcomes.
Data Extraction: Two investigators extracted data, assessed study quality, and graded the strength of the evidence.
Data Synthesis: Among 69 studies, 58 were in ambulatory settings, 52 reported process-of-care outcomes, and 38 reported patient outcomes. Low-strength evidence suggested that P4P programs in ambulatory settings may improve process-of-care outcomes over the short term (2 to 3 years), whereas data on longer-term effects were limited. Many of the positive studies were conducted in the United Kingdom, where incentives were larger than in the United States. The largest improvements were seen in areas where baseline performance was poor. There was no consistent effect of P4P on intermediate health outcomes (low-strength evidence) and insufficient evidence to characterize any effect on patient health outcomes. In the hospital setting, there was low-strength evidence that P4P had little or no effect on patient health outcomes and a positive effect on reducing hospital readmissions.
Limitation: Few methodologically rigorous studies; heterogeneous population and program characteristics and incentive targets.
Conclusion: Pay-for-performance programs may be associated with improved processes of care in ambulatory settings, but consistently positive associations with improved health outcomes have not been demonstrated in any setting.
Primary Funding Source: U.S. Department of Veterans Affairs.
PMID: 28114600 [PubMed - indexed for MEDLINE]
New Roles for Medical Assistants in Innovative Primary Care Practices.
Health Serv Res. 2017 Feb;52 Suppl 1:383-406
Authors: Chapman SA, Blash LK
OBJECTIVE: To identify and describe new roles for medical assistants (MAs) in innovative care models that improve care while providing training and career advancement opportunities for MAs.
DATA SOURCES/STUDY SETTING: Primary data collected at 15 case study sites; 173 key informant interviews and de-identified secondary data on staffing, wages, patient satisfaction, and health outcomes.
STUDY DESIGN: Researchers used snowball sampling and screening calls to identify 15 organizations using MAs in new roles. Conducted site visits from 2010 to 2012 and updated information in 2014.
DATA COLLECTION/EXTRACTION METHODS: Thematic analysis explored key topics: factors driving MA role innovation, role description, training required, and wage gains. Categorized outcome data in patient and staff satisfaction, quality of care, and efficiency.
PRINCIPAL FINDINGS: New MA roles included health coach, medical scribe, dual role translator, health navigator, panel manager, cross-trained flexible role, and supervisor. Implementation of new roles required extensive training. MA incentives and enhanced compensation varied by role type.
CONCLUSIONS: New MA roles are part of a larger attempt to reform workflow and relieve primary care providers. Despite some evidence of success, spread has been limited. Key challenges to adoption included leadership and provider resistance to change, cost of additional MA training, and lack of reimbursement for nonbillable services.
PMID: 27859097 [PubMed - indexed for MEDLINE]
Primary care nursing activities with patients affected by physical chronic disease and common mental disorders: a qualitative descriptive study.
J Clin Nurs. 2017 May;26(9-10):1385-1394
Authors: Girard A, Hudon C, Poitras ME, Roberge P, Chouinard MC
AIMS AND OBJECTIVES: To describe nursing activities in primary care with patients affected by physical chronic disease and common mental disorders.
BACKGROUND: Patients in primary care who are affected by physical chronic disease and common mental disorders such as anxiety and depression require care and follow-up based on their physical and mental health condition. Primary care nurses are increasingly expected to contribute to the care and follow-up of this growing clientele. However, little is known about the actual activities carried out by primary care nurses in providing this service in the Province of Quebec (Canada).
METHODS: A qualitative descriptive study was conducted. Data were obtained through semistructured individual interviews with 13 nurses practising among patients with physical chronic disease in seven Family Medicine Groups in Quebec (Canada).
RESULTS: Participants described five activity domains: assessment of physical and mental health condition, care planning, interprofessional collaboration, therapeutic relationship and health promotion.
CONCLUSION: The full potential of primary care nurses is not always exploited, and some activities could be improved. Evidence for including nurses in collaborative care for patients affected by physical chronic disease and common mental disorders has been shown but is not fully implemented in Family Medicine Groups. Future research should emphasise collaboration among mental health professionals, primary care nurses and family physicians in the care of patients with physical chronic disease and common mental disorders.
RELEVANCE TO CLINICAL PRACTICE: Primary care nurses would benefit from gaining more knowledge about common mental disorders and from identifying the resources they need to contribute to managing them in an interdisciplinary team.
PMID: 28000321 [PubMed - indexed for MEDLINE]
Interventions for prevention of bullying in the workplace.
Cochrane Database Syst Rev. 2017 01 30;1:CD009778
Authors: Gillen PA, Sinclair M, Kernohan WG, Begley CM, Luyben AG
BACKGROUND: Bullying has been identified as one of the leading workplace stressors, with adverse consequences for the individual employee, groups of employees, and whole organisations. Employees who have been bullied have lower levels of job satisfaction, higher levels of anxiety and depression, and are more likely to leave their place of work. Organisations face increased risk of skill depletion and absenteeism, leading to loss of profit, potential legal fees, and tribunal cases. It is unclear to what extent these risks can be addressed through interventions to prevent bullying.
OBJECTIVES: To explore the effectiveness of workplace interventions to prevent bullying in the workplace.
SEARCH METHODS: We searched: the Cochrane Work Group Trials Register (August 2014); Cochrane Central Register of Controlled Trials (CENTRAL; The Cochrane Library 2016, issue 1); PUBMED (1946 to January 2016); EMBASE (1980 to January 2016); PsycINFO (1967 to January 2016); Cumulative Index to Nursing and Allied Health Literature (CINAHL Plus; 1937 to January 2016); International Bibliography of the Social Sciences (IBSS; 1951 to January 2016); Applied Social Sciences Index and Abstracts (ASSIA; 1987 to January 2016); ABI Global (earliest record to January 2016); Business Source Premier (BSP; earliest record to January 2016); OpenGrey (previously known as OpenSIGLE-System for Information on Grey Literature in Europe; 1980 to December 2014); and reference lists of articles.
SELECTION CRITERIA: Randomised and cluster-randomised controlled trials of employee-directed interventions, controlled before and after studies, and interrupted time-series studies of interventions of any type, aimed at preventing bullying in the workplace, targeted at an individual employee, a group of employees, or an organisation.
DATA COLLECTION AND ANALYSIS: Three authors independently screened and selected studies. We extracted data from included studies on victimisation, perpetration, and absenteeism associated with workplace bullying. We contacted study authors to gather additional data. We used the internal validity items from the Downs and Black quality assessment tool to evaluate included studies' risk of bias.
MAIN RESULTS: Five studies met the inclusion criteria. They had altogether 4116 participants. They were underpinned by theory and measured behaviour change in relation to bullying and related absenteeism. The included studies measured the effectiveness of interventions on the number of cases of self-reported bullying either as perpetrator or victim or both. Some studies referred to bullying using common synonyms such as mobbing and incivility and antonyms such as civility. Organisational/employer level interventionsTwo studies with 2969 participants found that the Civility, Respect, and Engagement in the Workforce (CREW) intervention produced a small increase in civility that translates to a 5% increase from baseline to follow-up, measured at 6 to 12 months (mean difference (MD) 0.17; 95% CI 0.07 to 0.28).One of the two studies reported that the CREW intervention produced a small decrease in supervisor incivility victimisation (MD -0.17; 95% CI -0.33 to -0.01) but not in co-worker incivility victimisation (MD -0.08; 95% CI -0.22 to 0.08) or in self-reported incivility perpetration (MD -0.05 95% CI -0.15 to 0.05). The study did find a decrease in the number of days absent during the previous month (MD -0.63; 95% CI -0.92 to -0.34) at 6-month follow-up. Individual/job interface level interventionsOne controlled before-after study with 49 participants compared expressive writing with a control writing exercise at two weeks follow-up. Participants in the intervention arm scored significantly lower on bullying measured as incivility perpetration (MD -3.52; 95% CI -6.24 to -0.80). There was no difference in bullying measured as incivility victimisation (MD -3.30 95% CI -6.89 to 0.29).One controlled before-after study with 60 employees who had learning disabilities compared a cognitive-behavioural intervention with no intervention. There was no significant difference in bullying victimisation after the intervention (risk ratio (RR) 0.55; 95% CI 0.24 to 1.25), or at the three-month follow-up (RR 0.49; 95% CI 0.21 to 1.15), nor was there a significant difference in bullying perpetration following the intervention (RR 0.64; 95% CI 0.27 to 1.54), or at the three-month follow-up (RR 0.69; 95% CI 0.26 to 1.81). Multilevel InterventionsA five-site cluster-RCT with 1041 participants compared the effectiveness of combinations of policy communication, stress management training, and negative behaviours awareness training. The authors reported that bullying victimisation did not change (13.6% before intervention and 14.3% following intervention). The authors reported insufficient data for us to conduct our own analysis.Due to high risk of bias and imprecision, we graded the evidence for all outcomes as very low quality.
AUTHORS' CONCLUSIONS: There is very low quality evidence that organisational and individual interventions may prevent bullying behaviours in the workplace. We need large well-designed controlled trials of bullying prevention interventions operating on the levels of society/policy, organisation/employer, job/task and individual/job interface. Future studies should employ validated and reliable outcome measures of bullying and a minimum of 6 months follow-up.
PMID: 28134445 [PubMed - indexed for MEDLINE]
Social Media and Population Health Virtual Exchange for Senior Nursing Students: An International Collaboration.
Stud Health Technol Inform. 2016;225:975-6
Authors: Procter PM, Brixey JJ, Honey ML, Todhunter F
The authors have all engaged in using social media with students as a means for collaboration across national and international boundaries for various educational purposes. Following the explosion of big data in health the authors are now moving this concept forward within undergraduate and postgraduate nursing curricula for the development of population health virtual exchanges. Nursing has a global presence and yet it appears as though students have little knowledge of the health and social care needs and provision outside their local environment. This development will allow for explorative exchange amongst students in three countries, enhancing their understanding of their own and the selected international population health needs and solutions through asking and responding to questions amongst the learning community involved. The connection of the students will be recorded for their use in reflection; of particular interest will be the use of information included by the students to answer questions about their locality.
PMID: 27332439 [PubMed - indexed for MEDLINE]
The New Issue of Social Media in Education and Health Behavior Change - Virtual Visit of Tele-Nursing.
Stud Health Technol Inform. 2016;225:625-6
Authors: Chen BL
Tele-Nursing is a kind of virtual visits, to our nursing professional developed as a new future, based on Who's policy that is to deal with nursing shortage in the worldwide. Then how to connect the clinical phenomena to synthesis concept is top urgent. The systemic review method and case manager interview to collect the clinical phenomena, the concepts analyzed by Norris Method to analyze the virtual visit. Finally the results of research finding were five categories which were available; security; science and technology derived consequences for nursing; to monitor quality of nursing care; support from social network. The Virtual Visit of Tele-Nursing's concept will be leading nursing knowledge to theory.
PMID: 27332282 [PubMed - indexed for MEDLINE]
Responding to the support needs of frontline public health nurses who work with vulnerable families and children: A qualitative study.
Contemp Nurse. 2017 May 13;:1-19
Authors: Austin J, Holt S
BACKGROUND: This paper reports on a research study to inform the development of a specialist role designed to lead and support front line public health nurses (PHNs) working with vulnerable families and at risk children in Ireland. PHNs in Ireland provide a programme of intervention that promotes optimum health and wellbeing for all children in their early years under the governance of the Health Service Executive. This universal access places the PHN as a central participant in the safeguarding of young children, particularly those working in disadvantaged communities where frequent exposure to difficult situations is a common factor.
AIMS: The aims of this study were to identify best practice, investigate the position of a leading role and to explore the implications of such change.
METHODS: This study was conducted using a qualitative research design to collect informative data through focus group and semi-structured individual interview formats. The sample of ten participants was purposively selected from line management in public health nursing, social work and a non-governmental children's organisation who work in some of the most disadvantaged areas in Dublin.
RESULTS: Supported by empirical evidence, findings from the data indicate that assistant directors of public health nursing with significant experience in child protection and welfare are in a key position to inform decisions pertaining to the provision of services for children.
CONCLUSION: This study concluded that access to support and appropriate supervision are fundamental resource requirements for PHNs who work with vulnerable families and at risk children. The study further recommended that the introduction of a specialist- leading role to support these public health nurses was essential to sustaining best practice.
PMID: 28504060 [PubMed - as supplied by publisher]
Nurse practitioners and intent to retire.
J Am Assoc Nurse Pract. 2017 Mar;29(3):130-135
Authors: Falk NL, Rudner N, Chapa D, Greene J
BACKGROUND AND PURPOSE: Demand for primary care services is rising. Nurse practitioners (NPs) serve vital roles in meeting primary care demands. Workforce planning requires understanding NP retirement intentions. This study examines factors that relate to NPs, aged 55 years and older, and their intent to retire within 5 years.
METHODS: We used the 2012 National Sample Survey of Nurse Practitioners to examine the relationship between NP demographic characteristics (gender, race/ethnicity, marital status, nursing degree), work environment characteristics (part-time vs. full-time status, primary or specialty care, earnings, job satisfaction), and intent to retire. Descriptive, bivariate, and multivariate analyses were conducted. A total of 3171 working NPs, 55 years of age and older, were included.
CONCLUSIONS: Fifty-nine percent of NPs 60 years and older and 15% of NPs 55-59 intend to retire in the next 5 years. Working part-time and having less than a master's degree were associated with intent to retire. Being "very satisfied" with one's job was related to lower odds of intent to retire versus being "satisfied." Being "dissatisfied" with one's job and working in primary care were related to intending to retire for the NPs 55-59.
IMPLICATIONS FOR PRACTICE: Given the relationship between higher job satisfaction and lower intent to retire, efforts to increase NPs' job satisfaction may result in less early retirement.
PMID: 27717220 [PubMed - indexed for MEDLINE]
Professional online community membership and participation among healthcare providers: An extension to nurse practitioners and physician assistants.
J Am Assoc Nurse Pract. 2016 Dec;28(12):639-645
Authors: Betts KR, O'Donoghue AC, Aikin KJ, Kelly BJ, Boudewyns V
BACKGROUND AND PURPOSE: Professional online communities allow healthcare providers to exchange ideas with their colleagues about best practices for patient care. Research on this topic has focused almost exclusively on primary care physicians and specialists, to the exclusion of advanced practice providers such as nurse practitioners and physician assistants. We expand this literature by examining membership and participation on these websites among each of these provider groups.
METHODS: Participants (N = 2008; approximately 500 per provider group) responded to an Internet-based survey in which they were asked if they use professional online communities to dialogue with colleagues and if so, what their motivation is for doing so.
CONCLUSIONS: Nearly half of the participants in our sample reported utilizing professional online communities. Select differences were observed between provider groups, but overall, similar patterns emerged in their membership and participation on these websites.
IMPLICATIONS FOR PRACTICE: Nurse practitioners and physician assistants utilize professional online communities in similar proportion to primary care physicians and specialists. Providers should be cognizant of the impact this use may have for both themselves and their patients. Researchers are urged to take into account the various professional roles within the healthcare community while developing research on this topic.
PMID: 27214569 [PubMed - indexed for MEDLINE]
Using Education Technology as a Proactive Approach to Healthy Ageing.
Stud Health Technol Inform. 2016;225:193-7
Authors: Rodger D, Spencer A, Hussey P
Bone Health in the Park was created in Ireland and is an online health promotion education resource focussing on bone health, healthy ageing and falls prevention. The programme was designed by an Advanced Nurse Practitioner in collaboration with an Education Technologist and primarily uses storytelling to promote education specifically on bone health and falls risk prevention for health care professionals, clients, families and informal carers. This paper reports on core deliverables from this programme from 2010 to 2015, and provides insight into their development, in addition to details on its clinical effectiveness by using technology enhanced learning to underpin health promotion initiatives.
PMID: 27332189 [PubMed - indexed for MEDLINE]
Glycemic control: Can nurse practitioners on interprofessional collaborative practice teams enhance clinical outcomes?
J Am Assoc Nurse Pract. 2016 Dec;28(12):652-658
Authors: Parker RA, Hook LD, Jones ME
BACKGROUND AND PURPOSE: Care coordination and specialized knowledge of prescriptive authority are fundamental to advanced nursing practice. Little research documents patient clinical outcomes in primary care when nurse practitioners are members of an interprofessional education and collaborative practice (IPECP) team. This cross-sectional study examined differences in glycemic control among Texas patients who received care by a Family Nurse Practitioner (FNP) and an IPECP team in one calendar year.
METHODS: A convenience sample of 120 adult volunteers with diabetes was followed in a community-based clinic by an FNP; of these, 34 received additional care by an IPECP team. Data on selected demographic indices and HgbA1c were derived from the health center's Electronic Medical Record using a retrospective review, and linkage with the federally funded IPECP Project database.
CONCLUSIONS: Patients with two or more FNP visits and two or more visits with the IPECP team had statistically significant reductions in HgbA1c levels at the end of 1 year.
IMPLICATIONS FOR PRACTICE: Actualizing point-of-care treatment adjustments is a particular strength of advanced practice nurses but potentially a missed opportunity on interprofessional teams. Further study is needed on clinical outcomes of nurse practitioner contributions to IPECP team care.
PMID: 27479873 [PubMed - indexed for MEDLINE]
Transition Program to Promote Incoming Nursing Student Success in Higher Education.
Nurse Educ. 2016 Nov/Dec;41(6):319-323
Authors: Latham CL, Singh H, Lim C, Nguyen E, Tara S
A new model for addressing first-generation and minority student issues when starting nursing school was implemented using an interactive, peer-developed, 2-day program to create a sense of community and relieve anxiety. The program focused on students' needs, engagement, networking, first-hand experience with resources and methods to reduce cultural dissonance. Participation included critiquing modeling of proper clinical attire, meeting with peer mentors, and locating important campus resources. The program, conducted by minority students under the supervision and guidance of faculty mentors, received excellent evaluations.
PMID: 27022684 [PubMed - indexed for MEDLINE]
Review of the International Council of Nurses (ICN) Framework of Disaster Nursing Competencies.
Prehosp Disaster Med. 2016 Dec;31(6):680-683
Authors: Hutton A, Veenema TG, Gebbie K
The International Council of Nurses (ICN; Geneva, Switzerland) and the World Association for Disaster and Emergency Medicine (WADEM; Madison, Wisconsin USA) joined together in 2014 to review the use of the ICN Framework of Disaster Nursing Competencies. The existing ICN Framework (version 1.10; dated 2009) formed the starting point for this review. The key target audiences for this process were members of the disaster nursing community concerned with pre-service education for professional nursing and the continuing education of practicing professional nurses. To minimize risk in the disaster nursing practice, competencies have been identified as the foundation of evidence-based practice and standard development. A Steering Committee was established by the WADEM Nursing Section to discuss how to initiate a review of the ICN Framework of Disaster Nursing Competencies. The Steering Committee then worked via email to develop a survey to send out to disaster/emergency groups that may have nurse members who work/respond in disasters. Thirty-five invitations were sent out with 20 responses (57%) received. Ninety-five percent of respondents knew of the ICN Framework of Disaster Nursing Competencies, with the majority accessing these competencies via the Internet. The majority of those who responded said that they make use of the ICN Framework of Disaster Nursing Competencies with the most common use being for educational purposes. Education was done at a local, national, and international level. The competencies were held in high esteem and valued by these organizations as the cornerstone of their disaster education, and also were used for the continued professional development of disaster nursing. However, respondents stated that five years on from their development, the competencies also should include the psychosocial elements of nurses caring for themselves and their colleagues. Additionally, further studies should explore if there are other areas related to the disaster nursing practice (in addition to psychosocial concerns) that may be missing or not fully developed. Finally, the authors of this report recommend that future research explore how the ICN Framework of Disaster Nursing Competencies do or do not assist in maintaining best practices in this field and improve outcomes for victims of disaster. Hutton A , Veenema TG , Gebbie K . Review of the International Council of Nurses (ICN) Framework of Disaster Nursing Competencies. Prehosp Disaster Med. 2016;31(6):680-683.
PMID: 27646611 [PubMed - indexed for MEDLINE]
Evaluation of ConPrim: A three-part model for continuing education in primary health care.
Nurse Educ Today. 2016 Nov;46:115-120
Authors: Berggren E, Strang P, Orrevall Y, Ödlund Olin A, Sandelowsky H, Törnkvist L
BACKGROUND: To overcome the gap between existing knowledge and the application of this knowledge in practice, a three-part continuing educational model for primary health care professionals (ConPrim) was developed. It includes a web-based program, a practical exercise and a case seminar.
AIM: To evaluate professionals' perceptions of the design, pedagogy and adaptation to primary health care of the ConPrim continuing educational model as applied in a subject-specific intervention.
METHODS: A total of 67 professionals (nurses and physicians) completed a computer-based questionnaire evaluating the model's design, pedagogy and adaptation to primary health care one week after the intervention. Descriptive statistics were used.
RESULTS: Over 90% found the design of the web-based program and case seminar attractive; 86% found the design of the practical exercise attractive. The professionals agreed that the time spent on two of the three parts was acceptable. The exception was the practical exercise: 32% did not fully agree. Approximately 90% agreed that the contents of all parts were relevant to their work and promoted interactive and interprofessional learning. In response to the statements about the intervention as whole, approximately 90% agreed that the intervention was suitable to primary health care, that it had increased their competence in the subject area, and that they would be able to use what they had learned in their work.
CONCLUSIONS: ConPrim is a promising model for continuing educational interventions in primary health care. However, the time spent on the practical exercise should be adjusted and the instructions for the exercise clarified. ConPrim should be tested in other subject-specific interventions and its influence on clinical practice should be evaluated.
PMID: 27621201 [PubMed - indexed for MEDLINE]
Participants' perceptions of an intervention implemented in an Action Research Nursing Documentation Project.
J Clin Nurs. 2017 Apr;26(7-8):983-993
Authors: Vabo G, Slettebø Å, Fossum M
AIMS AND OBJECTIVES: The aim of this study is to describe healthcare professionals' experiences and perceptions of an intervention implemented in an action research project conducted to improve nursing documentation practices in four municipalities in Norway.
BACKGROUND: Documentation of individualized patient care is a continuing concern in healthcare services and could impacts the quality and safety of healthcare. Use of electronic systems has made some aspects of documentation more comprehensive, but creation of an individualized care plan remains a pressing issue.
DESIGN: A qualitative descriptive design was used.
METHODS: An action research project was conducted between 2010-2012 to improve the content and quality of nursing documentation in community healthcare services in four municipalities. One year after the project was completed four focus group interviews were conducted with healthcare professionals, one for each involved municipality. Two unit managers were interviewed individually. Qualitative content analysis was used.
RESULTS: Three themes emerged: healthcare professionals perceived competing interest; they experienced that they had to manage complexity and changes; and they highlighted a clear and visible leader as important for success.
CONCLUSIONS: Quality improvement activities are essential. Healthcare professionals experience a complicated situation when electronic health record systems do not support workflow. Further research is recommended to focus on the functionality and user interface of electronic health record systems, and on the role of leadership when implementing changes in clinical practice.
RELEVANCE TO CLINICAL PRACTICE: Stronger cooperation among policymakers, electronic health record system vendors, and healthcare professionals is essential for improving electronic health record systems and documentation practices. Involvement of end-users in these improvements can make a difference in the way the systems are perceived in the clinical workflow.
PMID: 27192412 [PubMed - indexed for MEDLINE]
Healthcare students as innovative partners in the development of future healthcare services: An action research approach.
Nurse Educ Today. 2016 Nov;46:4-9
Authors: Norbye B
BACKGROUND: Health care systems in Norway and the western world have experienced extensive changes due to patients living longer with complex conditions that require coordinated care. A Norwegian healthcare reform has led to significant restructuring in service delivery as a devolution of services to municipalities.
ACTION RESEARCH DESIGN: Partners from three rural healthcare services, students from four professional programmes, and one lecturer from each of the professional programmes used a collaborative approach to obtain new knowledge through interprofessional practice. Using an action research design, the research group facilitated democratic processes through dialogues with healthcare services and students. The design is visualised as a cyclical process in which each cycle contributes to improvements, innovations, and increased understanding. A total of 32 students and 3 supervisors were interviewed before and after the clinical practice experiences. Fieldwork was conducted during three clinical periods.
FINDINGS: Inter-professional student groups formed small healthcare teams and assessed patients with chronic and long-term conditions. Students prepared and negotiated patient follow-up. The teams' responsibilities led to reflective practices that enhanced their professional knowledge. The teams achieved a new understanding of patient situations, which influenced "second opinions" for patients with complex conditions and led to innovative practices. The change in perception of patient needs led to a changed professional approach. The students' perceptions changed as they learned from and about each other and in collaboration with the health service; this led to more coordinated care of patients with complex conditions. Inter-professional learning in community settings provided a platform to improve both healthcare education and rural healthcare services.
CONCLUSION: This research contributes to knowledge of how students' placement in inter-professional teams can enhance students learning from, with and about each other. The student teams promoted new ways of approaching and delivering complex patient treatment and care in community healthcare service. Collaborative partnerships in inter-professional learning have potential in the wider international arena as a means for practice improvement.
PMID: 27427864 [PubMed - indexed for MEDLINE]
Using blogs for facilitating and connecting nurse educator candidates.
Nurse Educ Today. 2016 Oct;45:35-41
Authors: Papastavrou E, Hamari L, Fuster P, Istomina N, Salminen L
BACKGROUND: Social media includes blog applications, which can be used as online journals or diaries that encourages interaction and collaboration within an online community. The aim of this study was to explore and describe the use of blog writing as learning journals during a short course for nurse educator candidates about social media.
METHOD: A qualitative descriptive design was used. The participants were nurses, Bachelor, Master's and Doctoral students who intended to follow a career in education (N=24, female n=21, male n=3, Mean age 37) from four different countries of the European Union. The blogs written during the course were used as a data collection method and the data was analyzed with qualitative content analysis.
RESULTS: A total of 260 blogger posts and 372 peer comments were analyzed. Four main categories emerged from the analysis: 1) Course content, new knowledge, and changed views, 2) Reflection and critical thinking, 3) Encouraging and peer support and 4) Expressing feelings, experiences, and expectations.
CONCLUSION: Blogs are potential learning spaces in short courses in nurse educator education, especially in sharing feelings and experiences, enhancing an encouraging atmosphere, critical thinking, and reflection.
PMID: 27429401 [PubMed - indexed for MEDLINE]
Impact of a stand-alone course in gerontological nursing on undergraduate nursing students' perceptions of working with older adults: A Quasi-experimental study.
Nurse Educ Today. 2016 Nov;46:17-23
Authors: Koehler AR, Davies S, Smith LR, Hooks T, Schanke H, Loeffler A, Carr C, Ratzlaff N
BACKGROUND: With an aging population, it is critical that nurses are educated and prepared to offer quality healthcare to this client group. Incorporating gerontology content into nursing curricula and addressing students' perceptions and career choices in relation to working with older adults are important faculty concerns.
OBJECTIVES: To examine the impact of a stand-alone course in gerontological nursing on undergraduate nursing students' perceptions of working with older adults and career intentions.
DESIGN: Quasi-experimental, pre- and post-test design.
SETTING: Medium-sized state university in the Mid Western United States PARTICIPANTS: Data were collected from three student cohorts during the spring semesters of 2012 (n=98), 2013 (n=80) and 2014 (n=88) for a total of N=266 with an average response rate of 85%.
METHODS: A survey instrument was administered via Qualtrics and completed by students prior to, and following completion of the course.
RESULTS: There was an overall significant increase (p=0.000) in positive perceptions of working with older adults among nursing students following completion of the course. The majority of participants (83.5%) reported having previous experience with older adults. Those with previous experience had higher perception scores at pre-test than those without (p=0.000). Post-test scores showed no significant difference between these two groups, with both groups having increased perception scores (p=0.120). Student preferences for working with different age groups suggested an overall increase in preference for working with older adults following the course.
CONCLUSIONS: A course in gerontological nursing, incorporating learning partnerships with community dwelling older adults, promotes positive perceptions of working with older adults, independently of the quality of prior experience. There was some evidence that students changed their preferences of working with different age groups in favor of working with older adults. Further research should be conducted to determine the mechanisms through which this takes place.
PMID: 27475123 [PubMed - indexed for MEDLINE]
The impact of educational experiences on nursing students' knowledge and attitudes toward people with Alzheimer's disease: A mixed method study.
Nurse Educ Today. 2016 Nov;46:57-63
Authors: Kimzey M, Mastel-Smith B, Alfred D
BACKGROUND: As the population ages, the effects of Alzheimer's disease will be felt by all nurses. Providing proper care for people with Alzheimer's disease is difficult and requires specific skills, attitudes, and knowledge. Limited data exists regarding nursing students' attitudes and knowledge toward people with Alzheimer's disease, whether undergraduate education prepares students to care for this population, or the best methods to support students in learning in an innovative and interactive environment.
OBJECTIVES: The aim of this study was to determine the effect of different educational experiences on nursing students' knowledge and attitudes toward people with Alzheimer's disease and to explore nursing students' knowledge and attitudes surrounding the care of people with Alzheimer's disease.
DESIGN: A convergent mixed method design. A three group (Alzheimer's disease clinical experience, online learning module, and no dementia-specific intervention), pretest and posttest design served as the quantitative arm of the study. A focus group discussion with themes extracted served as the qualitative piece of the study.
SETTING: College of Nursing in North Texas.
PARTICIPANTS: Convenience sample of 94 senior level nursing students enrolled in the undergraduate nursing program's Community Health course.
METHOD: Students completed pre and posttest surveys which included Alzheimer's Disease Knowledge Scale, Dementia Attitudes Scale, and demographic questionnaire. Content analysis was conducted on focus group responses to qualitative interview questions.
RESULTS: The Alzheimer's disease clinical group experienced increased knowledge and improved attitudes toward people with Alzheimer's disease compared with students who completed the online module or had no dementia-specific intervention. Four themes emerged from focus group data: Basic Alzheimer's disease knowledge, need for Alzheimer's disease experiential learning, negative feelings related to behaviors, and appropriate responses to behavioral and psychological symptoms of dementia.
CONCLUSION: Experiential learning in the form of clinical placements increased knowledge and improved attitudes about Alzheimer's disease compared with an online module and no dementia-specific intervention.
PMID: 27598794 [PubMed - indexed for MEDLINE]
A pilot study exploring the relationship between self-compassion, self-judgement, self-kindness, compassion, professional quality of life and wellbeing among UK community nurses.
Nurse Educ Today. 2016 Nov;46:109-114
Authors: Durkin M, Beaumont E, Hollins Martin CJ, Carson J
BACKGROUND: Compassion fatigue and burnout can impact on performance of nurses. This paper explores the relationship between self-compassion, self-judgement, self-kindness, compassion, professional quality of life, and wellbeing among community nurses.
AIM: To measure associations between self-compassion, compassion fatigue, wellbeing, and burnout in community nurses.
METHOD: Quantitative data were collected using standardised psychometric questionnaires: (1) Professional Quality of Life Scale; (2) Self-Compassion Scale; (3) short Warwick Edinburgh Mental Wellbeing Scale; (4) Compassion For Others Scale, used to measure relationships between self-compassion, compassion fatigue, wellbeing, and burnout.
PARTICIPANTS: A cross sectional sample of registered community nurses (n=37) studying for a postgraduate diploma at a University in the North of England took part in this study.
RESULTS: Results show that community nurses who score high on measures of self-compassion and wellbeing, also report less burnout. Greater compassion satisfaction was also positively associated with compassion for others, and wellbeing, whilst also being negatively correlated with burnout.
CONCLUSION: High levels of self-compassion were linked with lower levels of burnout. Furthermore when community nurses have greater compassion satisfaction they also report more compassion for others, increased wellbeing, and less burnout. The implications of this are discussed alongside suggestions for the promotion of greater compassion.
PMID: 27621200 [PubMed - indexed for MEDLINE]
Predictors of cultural competence among nursing students in the Philippines: A cross-sectional study.
Nurse Educ Today. 2016 Nov;46:121-126
Authors: Cruz JP, Estacio JC, Bagtang CE, Colet PC
BACKGROUND: With the continued emigration of Filipino nurses and increasing globalization, there is a need for globally competent nurses. Thus, the development of cultural competence among nursing students is critical in their preparation to assume their future responsibilities in the profession.
OBJECTIVES: This study investigated the predictors of cultural competence among nursing students in the Philippines.
DESIGN: This is a descriptive, cross-section study.
PARTICIPANTS AND SETTING: This study included 332 Bachelor of Science in nursing students in three nursing schools situated in the northern Philippines.
METHODS: The Cultural Capacity Scale was used to gather data from the respondents. The demographic characteristics and cultural background of the students were entered in a regression analysis to predict their cultural competence.
FINDINGS: The respondents manifested appreciably good cultural competence with a mean score of 68.98±11.73. The ability to understand the beliefs of various cultural groups received the highest mean of 3.65±0.86, while the ability to identify the care needs of patients with diverse cultural backgrounds received the lowest (mean, 3.31±0.74). Living in an environment with culturally diverse people, prior diversity training, being in the latter years of the nursing program, and with experience of caring for patients from diverse cultures and special population groups, were identified as predictors, accounting for 68.1% of the variance of cultural competence.
CONCLUSIONS: Nursing education should devise strategies to ensure future culturally competent Filipino nurses. Considering the fact that most of the Filipino nurses will potentially work overseas, they should be well prepared to provide competent care that is culturally sensitive.
PMID: 27636832 [PubMed - indexed for MEDLINE]
Augmented Nurse Care Management in CKD Stages 4 to 5: A Randomized Trial.
Am J Kidney Dis. 2017 Apr 07;:
Authors: Fishbane S, Agoritsas S, Bellucci A, Halinski C, Shah HH, Sakhiya V, Balsam L
BACKGROUND: Outcomes for patients with late-stage chronic kidney disease (CKD) in the United States are suboptimal. There is poor education and preparation for end-stage kidney disease, as well as a high rate of hospitalization in this group of patients.
STUDY DESIGN: A randomized, parallel-group, 2-arm, controlled trial.
SETTING & PARTICIPANTS: The study was conducted at 3 sites: a clinic of an academic medical center, a public hospital academic clinic, and a community-based private practice. All participants had late-stage CKD (stages 4-5 CKD). Patients were excluded only if they had significant cognitive impairment.
INTERVENTION: The care management intervention involved nurse care manager coordination aided by the use of a disease-based informatics system for monitoring patients' clinical status, enhancing CKD education, and facilitating preparation for end-stage kidney disease. The comparison control group received usual late-stage CKD care alone.
OUTCOMES: The primary outcome was rate of hospitalization.
MEASUREMENTS: Rates of preemptive transplantation, home dialysis, hemodialysis (HD) starts without a hospitalization, and HD therapy initiation rates with catheters or with functioning accesses.
RESULTS: 130 patients were randomly assigned. The hospitalization rate was significantly lower in the intervention group versus controls: 0.61 versus 0.92 per year, respectively (incidence rate ratio, 0.66; 95% CI, 0.43-0.99; P=0.04). Peritoneal dialysis or preemptive transplantation was the initial end-stage kidney disease treatment in 11 of 30 (37%) participants receiving the intervention versus 3 of 29 (10%) receiving usual care. Among HD starts, treatment was initiated without hospitalization in 11 of 19 (58%) participants in the intervention group versus 6 of 26 (23%) in the control group. At the time of HD therapy initiation, a catheter was present in 7 of 19 (37%) participants in the intervention group versus 18 of 26 (69%) in the control group. A functioning arteriovenous access was in place in 10 of 19 (53%) participants in the intervention group and 7 of 26 (27%) in the control group LIMITATIONS: Moderate sample size, limited geographic scope.
CONCLUSIONS: The augmented nurse care management intervention resulted in reduced hospitalizations in late-stage CKD and there were suggestions of improved end-stage kidney disease preparation. Given suboptimal outcomes in late-stage CKD, care management interventions could potentially improve patient outcomes.
PMID: 28396108 [PubMed - as supplied by publisher]
Prison nursing and its training.
Rev Esp Sanid Penit. 2016 Dec;18(3):110-118
Authors: Sánchez-Roig M, Coll-Cámara A
The main task of nurses is to take care of sick and healthy people and evaluate changes in their health conditions. The goal is to take the appropriate measures to help their recovery or guarantee a dignified death, and if possible, help them regain autonomy and independence. Nursing is present in different areas: primary health, mental health, accident and emergencies, intensive and coronary care, surgical care, paediatrics, geriatrics, public health, occupational health, teaching, etc. In our case, prison nursing, one of the least known branches of the profession, we wanted to investigate more deeply the work of nurses in prisons, which aspect of health care they are responsible for and to what type of population they are geared towards, as well as the necessary training to be able to work in such a particular environment. To conclude, we have seen that university degrees in general nursing do not include knowledge in this area, and that authors from different countries support the specialization of prison nursing and the need for nurses to be trained according to the health conditions of inmates and the characteristics of prisons.
PMID: 27831598 [PubMed - indexed for MEDLINE]
Clinical and cost effectiveness of nurse-led self-management interventions for patients with copd in primary care: A systematic review.
Int J Nurs Stud. 2017 Mar 31;71:125-138
Authors: Baker E, Fatoye F
BACKGROUND AND OBJECTIVE: Chronic obstructive pulmonary disease is increasing in prevalence and constitutes a major cause of morbidity and mortality globally. As well as contributing to a significant decline in health status in many patients, this condition creates a considerable burden on healthcare providers. Self-management interventions are frequently implemented in community settings to limit the impact of chronic obstructive pulmonary disease on everyday life of individuals and to manage pressure on health systems. Nurses are the most likely professional group to provide self-management support. This systematic review aims to evaluate the clinical and cost effectiveness of nurse-led self-management for patients with chronic obstructive pulmonary disease in primary care.
DESIGN: A systematic review was conducted to identify randomized controlled studies comparing nurse-led self-management interventions to usual care DATA SOURCES: Seven electronic databases, including British Nursing Index, MEDLINE, CINAHL, AMED, EMBASE, Cochrane Library and NHS Economic Evaluation Database, were searched for relevant studies.
REVIEW METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was used to guide the structure of the review. The relevance of citations was assessed based on inclusion criteria, with full texts retrieved as required to reach a decision. Data extraction was performed independently by two reviewers. The Cochrane risk of bias tool was used to undertake a quality review. A narrative summary method was used to describe review findings.
RESULTS: Twenty-six articles describing 20 randomised controlled trials were included in the analysis. Self-management interventions were heterogeneous, with a variable number of components, level of support, mode of delivery and length of follow up. The review demonstrated that nurse-led self-management programmes may be associated with reductions in anxiety and unscheduled physician visits and increases in self-efficacy, but definitive conclusions could not be reached. Few studies addressed economic outcomes and the diverse perspectives, time frames and settings made comparisons difficult. Evidence on cost-effectiveness was inconclusive.
CONCLUSIONS: Some nurse-led self-management programmes in this systematic review produced beneficial effects in terms of reducing unscheduled physician visits, lowering patients' anxiety and increasing self-efficacy, but there is insufficient evidence to reach firm conclusions on the clinical or cost-effectiveness of the interventions. Further research should aim to identify the optimal components of these programmes and to identify those patients most likely to benefit. The inclusion of economic analyses in future studies would facilitate decisions by policy makers on the implementation of self-management interventions.
PMID: 28399427 [PubMed - as supplied by publisher]
Characteristics of Nurse Directors That Contribute to Registered Nurse Satisfaction.
J Nurs Adm. 2017 Apr;47(4):219-225
Authors: Burke D, Flanagan J, Ditomassi M, Hickey PA
OBJECTIVE: The aim of this study was to explore RNs and nurse directors' (NDs') perceptions of leadership on units with high RN satisfaction scores.
BACKGROUND: Identifying the characteristics of NDs that contribute to RN satisfaction is important in the recruitment and retention of RNs and in the selection and role development of NDs.
METHODS: This study used a qualitative design using appreciative inquiry-guided data collection.
RESULTS: Nine RNs and 9 NDs met the inclusion criteria. Each group identified 4 themes.
CONCLUSIONS: Registered nurse and ND participants identified similar themes representative of leadership attributes and behaviors that contribute to RN satisfaction.
PMID: 28333790 [PubMed - indexed for MEDLINE]
Impact of Participation in Community-Based Research Among Undergraduate and Graduate Students.
J Allied Health. 2017;46(1):e15-e24
Authors: George CL, Wood-Kanupka J, Oriel KN
Participation in community-based research provides college students with a high-impact experience involving both research and service learning. Presently, the impact of participation in community-based research projects has been measured most often through the use of post-learning course evaluations and case studies. The authors describe the impact of participation in community-based research, at a small liberal arts college, on undergraduate education students and graduate physical therapy students using the Community-Based Research Student Learning Outcomes Survey. Results from 2 years of survey responses and open-ended responses suggest that participation in such an experience may impact professional and personal growth, educational experiences, and civic engagement. This study provides support for universities and colleges to continue offering high-impact learning experiences for students by utilizing community-based research experiences while collaborating between academic departments.
PMID: 28255600 [PubMed - indexed for MEDLINE]
Exploring healthcare assistants' role and experience in pain assessment and management for people with advanced dementia towards the end of life: a qualitative study.
BMC Palliat Care. 2017 Jan 19;16(1):6
Authors: Jansen BW, Brazil K, Passmore P, Buchanan H, Maxwell D, McIlfatrick SJ, Morgan SM, Watson M, Parsons C
BACKGROUND: Pain assessment and management are key aspects in the care of people with dementia approaching the end of life but become challenging when patient self-report is impaired or unavailable. Best practice recommends the use of observational pain assessments for these patients; however, difficulties have been documented with health professionals' use of these tools in the absence of additional collateral patient knowledge. No studies have explored the role, perspectives and experiences of healthcare assistants in pain assessment and management in dementia; this study provides insight into this important area.
METHODS: A qualitative approach was adopted, using key informant interviews with healthcare assistants caring for people with advanced dementia approaching the end of life in hospice, nursing home and acute care settings. Thematic analysis was the analytic approach taken to interpretation of interview data. Data were collected between June 2014 and September 2015.
RESULTS: Fourteen participants took part in the study. Participants' average length of caring experience was 15.4 years and most were female. Three key themes emerged: recognising pain, reporting pain, and upskilling. Participants were often the first to notice obvious causes of pain and to detect changes in patient norms which signified hidden causes of pain. Comprehensive knowledge of resident norms enabled participants to observe for behavioural and nonverbal indicators of pain and distinguish these from non-pain related behaviours. Pain reporting was heavily impacted by relationships with professional staff and the extent to which participants felt valued in their role. Positive relationships resulted in comprehensive pain reports; negative relationships led to perfunctory or ambiguous reporting. Participants emphasised a desire for further training and upskilling, including in the use and reporting of basic pain tools.
CONCLUSIONS: Healthcare assistants are frontline staff who have a key role in direct patient care, spending a considerable amount of time with patients in comparison to other health professionals. These staff are often first to notice changes in patients that may signify pain and to alert professional staff. However, to ensure the quality of these reports, further efforts must be made in reversing stigma attached to this role and in upskilling these members of the healthcare team.
PMID: 28103847 [PubMed - indexed for MEDLINE]
Developing an outcomes framework for the dietetic service.
Br J Community Nurs. 2016 Dec 02;21(12):599-605
Authors: Prendiville V
Demonstrating our value as individual practitioners and services is a key priority. Developing robust process and outcome measures supports us to achieve this. Outcomes also enable us to provide the highest level of patient-centred care by helping us to re-model the relationship between user and provider through capturing and using patient-related experience and outcome measures to inform service development. This article discusses our journey as a dietetic service in developing and implementing an outcomes framework utilising quality improvement methodology. This work was undertaken as part of a Silver 'Improving Quality Together' (IQT) project, a 1000 Lives initiative ( NHS Wales, 2013 ). Find out more about improving quality together at www.IQT.wales.nhs.uk .
PMID: 27922778 [PubMed - indexed for MEDLINE]
Nursing home nurses' and community-dwelling older adults' reported knowledge, attitudes, and behavior toward antibiotic use.
BMC Nurs. 2017;16:12
Authors: Kistler CE, Beeber A, Becker-Dreps S, Ward K, Meade M, Ross B, Sloane PD
BACKGROUND: Antibiotic overuse causes antibiotic resistance, one of the most important threats to human health. Older adults, particularly those in nursing homes, often receive antibiotics when they are not indicated.
METHODS: To understand knowledge, attitudes, and behaviors of nursing home (NH) nurses and community-dwelling older adults towards antibiotic use, especially in clinical situations consistent with antibiotic overuse, we conducted a mixed-method survey in two NHs and one Family Medicine clinic in North Carolina, among English-speaking nurses and community-dwelling, cognitively intact adults aged 65 years or older. Based on the Knowledge-Attitude-Practice model, the survey assessed knowledge, attitudes, and behavior towards antibiotic use, including three vignettes designed to elicit possible antibiotic overuse: asymptomatic bacteriuria (ASB), a viral upper respiratory illness (URI), and a wound from a fall.
RESULTS: Of 31 NH nurses and 66 community-dwelling older adults, 70% reported knowledge of the dangers of taking antibiotics. Nurses more often reported evidence-based attitudes towards antibiotics than older adults, except 39% agreed with the statement "by the time I am sick enough to go to the doctor with a cold, I expect an antibiotic", while only 28% of older adults agreed with it. A majority of nurses did not see the need for antibiotics in any of the three vignettes: 77% for the ASB vignette, 87% for the URI vignette, and 97% for the wound vignette. Among older adults, 50% did not perceive a need for antibiotics in the ASB vignette, 58% in the URI vignette, and 74% in the wound vignette.
CONCLUSIONS: While a substantial minority had no knowledge of the dangers of antibiotic use, non-evidence-based attitudes towards antibiotics, and behaviors indicating inappropriate management of suspected infections, most NH nurses and community-dwelling older adults know the harms of antibiotic use and demonstrate evidence-based attitudes and behaviors. However, more work is needed to improve the knowledge, attitudes and behaviors that may contribute to antibiotic overuse.
PMID: 28293145 [PubMed]
Two Essential Roles: Health Care Network Nurse Leaders and Local Nurse Leaders.
Nurs Adm Q. 2016 Oct-Dec;40(4):312-5
Authors: Schneider M
American health care organizations are experiencing increasing change driven by emerging partnerships, market demographics, population health initiatives, and merger and acquisition trends. The health care business environment necessitates alterations in how companies operate on a larger scale. New regional leadership roles are being created to provide leadership to systematize networks, build market share, and strengthen market needs. It is important and necessary to explore, review, and contrast the roles, skills, and behaviors of regional leader's roles and the solo organization leaders. It is also imperative to review the benefits of new affiliations for the community and hospital entity.
PMID: 27584890 [PubMed - indexed for MEDLINE]
Gendering Guilt among Dependent Family Members' Caregivers.
Span J Psychol. 2016 Nov 17;19:E80
Authors: Brea MT, Albar MJ, Casado-Mejia R
This study analyzes guilt among family caregivers of dependent patients, from a gender perspective. A qualitative design was used, conducting in-depth interviews and focus groups. Using purposive sampling, we selected 73 family caregivers and 23 health professionals (family medicine, community nursing, and social work) from the Primary Care District of Seville. The content of the information collected was analyzed in terms of the following categories: a) guilt for abandoning family and friends; b) guilt for the relationship with the dependent person; and c) guilt for placing the relative in a nursing home. To validate the findings, data sources, methodological techniques, and researchers' disciplines were all triangulated. Results indicated that women report more guilt than men for abandoning family and friends, and because of their relationship with the dependent person. However, with respect to nursing home placement, no difference was observed as a function of gender. The high incidence of caregiver guilt needs to be addressed by health professionals to avoid the emergence of other mental health issues.
PMID: 27852347 [PubMed - indexed for MEDLINE]
Community nurse's knowledge, confidence and experience of the Mental Capacity Act in practice.
Br J Community Nurs. 2016 Dec 02;21(12):615-622
Authors: Marshall H, Sprung S
The Mental Capacity Act (MCA) is statutory legislation introduced in 2007 to protect and empower people to make decisions for themselves and those who were deemed as unable to make choices would have decisions made on their behalf, often by health professionals. All health professionals must follow the guiding principles of this legislation. Yet a scrutiny report by the House of Lords concluded this legislation was under-used with a lack of knowledge among professionals regarding applying the legislation in practice. A review of the literature also supports these findings. A mixed method study was carried out among adult community nurses to explore if these findings were applicable within a health trust in the North West region. An electronic questionnaire (n=60), focus group (n=7) and a paired interview (n=2) were utilised to collect data regarding community nurse's experience and confidence of using the MCA in practice. Analysis identified key themes: training, knowledge and confidence among staff, working together with the wider multidisciplinary team, empowerment and improving documentation. While findings suggest clear examples of self-appraised confidence and excellent patient care, there is also scope for development regarding the knowledge and utilisation of the MCA in the clinical practice of community nurses.
PMID: 27922781 [PubMed - indexed for MEDLINE]
Simulation in undergraduate paediatric nursing curriculum: Evaluation of a complex 'ward for a day' education program.
Nurse Educ Pract. 2017 Feb 04;23:40-47
Authors: Gamble AS
Simulation in health education has been shown to increase confidence, psychomotor and professional skills, and thus positively impact on student preparedness for clinical placement. It is recognised as a valuable tool to expose and engage students in realistic patient care encounters without the potential to cause patient harm. Although inherent challenges exist in the development and implementation of simulation, variability in clinical placement time, availability and quality dictates the need to provide students with learning opportunities they may otherwise not experience. With this, and a myriad of other issues providing the impetus for improved clinical preparation, 28 final semester undergraduate nursing students in a paediatric nursing course were involved in an extended multi-scenario simulated clinical shift prior to clinical placement. The simulation focussed on a complex ward experience, giving students the opportunity to demonstrate a variety of psychomotor skills, decision making, leadership, team work and other professional attributes integral for successful transition into the clinical arena. Evaluation data were collected at 3 intermittent points; post-simulation, post clinical placement, and 3 months after commencing employment as a Registered Nurse. Quantitative and qualitative analysis suggested positive impacts on critical nursing concepts and psychomotor skills resulted for participants in both clinical placement and beyond into the first months of employment.
PMID: 28214431 [PubMed - as supplied by publisher]
Hospital Administration and Nursing Leadership in Disasters: An Exploratory Study Using Concept Mapping.
Nurs Adm Q. 2017 Apr/Jun;41(2):151-163
Authors: Veenema TG, Deruggiero K, Losinski S, Barnett D
Strong leadership is critical in disaster situations when "patient surge" challenges a hospital's capacity to respond and normally acceptable patterns of care are disrupted. Activation of the emergency operations plan triggers an incident command system structure for leadership decision making. Yet, implementation of the emergency operations plan and incident command system protocols is ultimately subject to nursing and hospital leadership at the service- and unit level. The results of these service-/unit-based leadership decisions have the potential to directly impact staff and patient safety, quality of care, and ultimately, patient outcomes. Despite the critical nature of these events, nurse leaders and administrators receive little education regarding leadership and decision making during disaster events. The purpose of this study is to identify essential competencies of nursing and hospital administrators' leadership during disaster events. An integrative mixed-methods design combining qualitative and quantitative approaches to data collection and analysis was used. Five focus groups were conducted with nurse leaders and hospital administrators at a large urban hospital in the Northeastern United States in a collaborative group process to generate relevant leadership competencies. Concept Systems Incorporated was used to sort, prioritize, and analyze the data (http://conceptsystemsinc.com/). The results suggest that participants' institutional knowledge (of existing resources, communications, processes) and prior disaster experience increase leadership competence.
PMID: 28263273 [PubMed - in process]
Are community-based nurse-led self-management support interventions effective in chronic patients? Results of a systematic review and meta-analysis.
PLoS One. 2017;12(3):e0173617
Authors: Massimi A, De Vito C, Brufola I, Corsaro A, Marzuillo C, Migliara G, Rega ML, Ricciardi W, Villari P, Damiani G
The expansion of primary care and community-based service delivery systems is intended to meet emerging needs, reduce the costs of hospital-based ambulatory care and prevent avoidable hospital use by the provision of more appropriate care. Great emphasis has been placed on the role of self-management in the complex process of care of patient with long-term conditions. Several studies have determined that nurses, among the health professionals, are more recommended to promote health and deliver preventive programs within the primary care context. The aim of this systematic review and meta-analysis is to assess the efficacy of the nurse-led self-management support versus usual care evaluating patient outcomes in chronic care community programs. Systematic review was carried out in MEDLINE, CINAHL, Scopus and Web of Science including RCTs of nurse-led self-management support interventions performed to improve observer reported outcomes (OROs) and patients reported outcomes (PROs), with any method of communication exchange or education in a community setting on patients >18 years of age with a diagnosis of chronic diseases or multi-morbidity. Of the 7,279 papers initially retrieved, 29 met the inclusion criteria. Meta-analyses on systolic (SBP) and diastolic (DBP) blood pressure reduction (10 studies-3,881 patients) and HbA1c reduction (7 studies-2,669 patients) were carried-out. The pooled MD were: SBP -3.04 (95% CI -5.01--1.06), DBP -1.42 (95% CI -1.42--0.49) and HbA1c -0.15 (95% CI -0.32-0.01) in favor of the experimental groups. Meta-analyses of subgroups showed, among others, a statistically significant effect if the interventions were delivered to patients with diabetes (SBP) or CVD (DBP), if the nurses were specifically trained, if the studies had a sample size higher than 200 patients and if the allocation concealment was not clearly defined. Effects on other OROs and PROs as well as quality of life remain inconclusive.
PMID: 28282465 [PubMed - in process]
Setting health priorities in a community: a case example.
Rev Saude Publica. 2017 Mar 02;51(0):11
Authors: Sousa FA, Goulart MJ, Braga AM, Medeiros CM, Rego DC, Vieira FG, Pereira HJ, Tavares HM, Loura MM
OBJECTIVE: To describe the methodology used in the process of setting health priorities for community intervention in a community of older adults.
METHODS: Based on the results of a health diagnosis related to active aging, a prioritization process was conceived to select the priority intervention problem. The process comprised four successive phases of problem analysis and classification: (1) grouping by level of similarity, (2) classification according to epidemiological criteria, (3) ordering by experts, and (4) application of the Hanlon method. These stages combined, in an integrated manner, the views of health team professionals, community nursing and gerontology experts, and the actual community.
RESULTS: The first stage grouped the identified problems by level of similarity, comprising a body of 19 issues for analysis. In the second stage these problems were classified by the health team members by epidemiological criteria (size, vulnerability, and transcendence). The nine most relevant problems resulting from the second stage of the process were submitted to expert analysis and the five most pertinent problems were selected. The last step identified the priority issue for intervention in this specific community with the participation of formal and informal community leaders: Low Social Interaction in Community Participation.
CONCLUSIONS: The prioritization process is a key step in health planning, enabling the identification of priority problems to intervene in a given community at a given time. There are no default formulas for selecting priority issues. It is up to each community intervention team to define its own process with different methods/techniques that allow the identification of and intervention in needs classified as priority by the community.
Nurse practitioner screening for childhood adversity among adult primary care patients: A mixed-method study.
J Am Assoc Nurse Pract. 2017 Jan;29(1):35-45
Authors: Kalmakis KA, Chandler GE, Roberts SJ, Leung K
BACKGROUND AND PURPOSE: Researchers have demonstrated an association between experiencing childhood abuse and multiple chronic health conditions in adulthood, yet this evidence has not been routinely translated to practice. The purpose of this research study was to examine nurse practitioner (NP) practices, skills, attitudes, and perceived barriers associated with screening adult patients for childhood abuse to determine the extent to which evidence of the association between childhood abuse and negative health outcomes has been translated to NP practice.
METHODS: A mixed-method approach with web-based questionnaires and online focus groups was used to examine NP screening for histories of childhood abuse.
CONCLUSIONS: A total of 188 complete NP surveys were analyzed along with data from focus groups with 12 NPs. One third of the NPs regularly screened for childhood abuse and believed screening was their responsibility. Six barriers, including insufficient time and lack of confidence when inquiring about abuse, were significantly associated with NP screening practices. The focus group participants discussed how and when one should ask about childhood abuse, and the need for education about screening.
IMPLICATIONS FOR PRACTICE: Time constraints and NPs' lack of confidence in their ability to screen for histories of childhood abuse must be addressed to encourage routine screening in primary care practice.
PMID: 27221514 [PubMed - indexed for MEDLINE]
The Direct Observation of Nurse Practitioner Care study: An overview of the NP/patient visit.
J Am Assoc Nurse Pract. 2017 Jan;29(1):46-57
Authors: Weyer SM, Cook ML, Riley L
BACKGROUND AND PURPOSE: While there is a preponderance of studies that demonstrate the quality of nurse practitioner (NP) practice, little is known on the practice style of NPs. The Direct Observation of Nurse Practitioner Care study provided the first national direct observation and characterization of patient care delivered by primary care NPs.
METHODS: The setting for this study was ambulatory care practices of NPs located throughout the United States. A nested sample was utilized, consisting of 22 NPs during visits with 245 patients. Observational data were collected during each visit using the Davis observation code (DOC). Patient information was collected from chart reviews and postvisit surveys. Each NP filled out a demographic and practice survey.
CONCLUSIONS: Visits to NPs were 18 min on average, and were most frequently for new/acute problems (45.1%) or routine chronic problems (30.2%). Overall, NPs spent the most time planning treatment, history taking, and providing health education. Topics that NPs frequently provided health education about included medication action and side effects, disease process education, diet, and nutrition.
IMPLICATIONS FOR PRACTICE: Data from this study will allow for detailed characterizations of a patient-NP visit and average length of the visit and the time use based on the DOC.
PMID: 27973706 [PubMed - indexed for MEDLINE]
Screening and brief intervention for unhealthy substance use in patients with chronic medical conditions: a systematic review.
J Clin Nurs. 2016 Nov;25(21-22):3131-3143
Authors: Timko C, Kong C, Vittorio L, Cucciare MA
AIMS AND OBJECTIVES: This systematic review describes studies evaluating screening tools and brief interventions for addressing unhealthy substance use in primary care patients with hypertension, diabetes or depression.
BACKGROUND: Primary care is the main entry point to the health care system for most patients with comorbid unhealthy substance use and chronic medical conditions. Although of great public health importance, systematic reviews of screening tools and brief interventions for unhealthy substance use in this population that are also feasible for use in primary care have not been conducted.
DESIGN: Systematic review.
METHODS: We systematically review the research literature on evidence-based tools for screening for unhealthy substance use in primary care patients with depression, diabetes and hypertension, and utilising brief interventions with this population.
RESULTS: Despite recommendations to screen for and intervene with unhealthy substance use in primary care patients with chronic medical conditions, the review found little indication of routine use of these practices. Limited evidence suggested the Alcohol Use Disorders Identification Test and Alcohol Use Disorders Identification Test-C screeners had adequate psychometric characteristics in patients with the selected chronic medical conditions. Screening scores indicating more severe alcohol use were associated with health-risk behaviours and poorer health outcomes, adding to the potential usefulness of screening for unhealthy alcohol use in this population.
CONCLUSIONS: Studies support brief interventions' effectiveness with patients treated for hypertension or depression who hazardously use alcohol or cannabis, for both substance use and chronic medical condition outcomes.
RELEVANCE TO CLINICAL PRACTICE: Although small, the international evidence base suggests that screening with the Alcohol Use Disorders Identification Test or Alcohol Use Disorders Identification Test-C and brief interventions for primary care patients with chronic medical conditions, delivered by nurses or other providers, are effective for identifying unhealthy substance use and associated with healthy behaviours and improved outcomes. Lacking are studies screening for illicit drug use, and using single-item screening tools, which could be especially helpful for frontline primary care providers including nurses.
PMID: 27140392 [PubMed - indexed for MEDLINE]
Comparison of menstrual disorders in hospital nursing staff according to shift work pattern.
J Clin Nurs. 2016 Nov;25(21-22):3291-3299
Authors: Albert-Sabater JA, Martínez JM, Baste V, Moen BE, Ronda-Perez E
AIM AND OBJECTIVE: To assess the association between work in a rotating shift schedule and menstruation characteristics among nurse staff in a prospective study.
BACKGROUND: Rotating shifts have been linked to alterations in the reproductive cycle. In the case of menstrual alterations, the conclusions are not clear.
DESIGN: Prospective epidemiological study with follow-up over four months.
METHOD: All the female nurse staff (<40 years) in a hospital were interviewed, collecting sociodemographic and employment information. They were given a menstrual diary to keep a record of their shifts and characteristics of their menstruation (duration, amount of blood, dysmenorrhoea). They had two types of shifts: (1) Rotating shift schedule (two mornings, two afternoons, one night and two days off) including morning shifts (8:00-15:00), afternoon/evening shifts (15:00-22:00) and night shifts (22:00-8:00), and (2) Day shift schedule including morning shifts (8:00-15:00) and/or afternoon/evening shifts (15:00-22:00). The crude and adjusted odds ratios with 95% confidence interval were calculated using logistic generalised estimating equations (GEE) taking into account the correlations of multiple cycles per worker.
RESULTS: One hundred and thirteen workers on the rotating shift and 75 on the day shift participated, and information from 730 menstrual cycles were obtained. There were no differences in prolonged duration, dysmenorrhoea, prolonged duration dysmenorrhoea and excessive bleeding among nurses on rotating shift compared to those on the day shift. For prolonged duration of menstruation, workers with more than five years on the rotating shift showed a slightly lower (nonsignificant) risk compared with those with <5 years.
CONCLUSIONS: Nurse staff on the rotating shift did not show increased risk of having menstrual disorders comparing with day staff.
RELEVANCE TO CLINICAL PRACTICE: Shifts with short rotation cycles and a progressive sequence do not appear to cause menstrual disorders in nurse staff who work rotating shifts.
PMID: 27530371 [PubMed - indexed for MEDLINE]
Facilitating terminal discharge: fulfilling the hospitalised patient's wish for home death in the final hours.
Int J Palliat Nurs. 2016 Nov 02;22(11):541-548
Authors: Tan YY, Xu ZZ, Pang GS, Qu L, Xu Y, Zhang AM, Neo PS
BACKGROUND: Terminal discharge (TD) is the rapid discharge of a hospitalised patient when death is imminent. Its time-limited nature makes it challenging, particularly for ward nurses.
AIM: To report the development of a structured TD framework, and determine if the framework can expedite TD processes and improve nurses' experience in conducting TDs.
METHODS: A 3-phase audit was carried out in a Singapore hospital. The baseline and post intervention audits evaluated the time taken for TD, incidence of prescription errors, continuity of care, and timeliness of equipment arrangement. Nurse satisfaction was assessed through a written survey. Interventions encompassed the implementation of workflow changes and a TD guide.
RESULTS: The mean time taken to complete TDs was shorter in the post-compared to pre-intervention phase (2.9±1.4 vs. 4.6±2.3 hours respectively, p<0.01). Approximately 89% of nurses who used the TD guide were satisfied that it made TDs easier.
CONCLUSION: A structured TD framework is effective in expediting TDs and improving nurse satisfaction.
PMID: 27885905 [PubMed - indexed for MEDLINE]